^\»  DOCTOR'S 
LIABLE  "TAL/K 


JAIVfES  •  G  •  MUMI'Ol^ 


Digitized  by  tine  Internet  Arcliive 

in  2007  witli  funding  from 

IVIicrosoft  Corporation 


littp://www.arcliive.org/details/doctorstabletalkOOmumfiala 


A   DOCTOR'S  TABLE   TALK 


\A  DOCTOR'S 
TABLE  TALK^ 

BY  JAMES  GREGORY  MUMFORD,M.D. 

LECTURER    ON    SURGERY   IN  HARVARD    UNIVERSITY,  ETC. 


BOSTON   AND   NEW  YORK 
HOUGHTON   MIFFLIN   COMPANY 

1912 


COPYRIGHT,   I913,  BY  JAMES  GREGORY  MUMFORO 
ALL  RIGHTS   RESERVED 

PuhlisJitd  October  iQia 


TO 
S.   WEIR   MITCHELL 

GREAT    PHYSICIAN    AND    BELOVED    MAN    OF    LETTERS 

THIS    BOOK    WITH    SINCERE    AFFECTION 

IS    INSCRIBED    BY 

THE  WRITER 


NOTE 

In  consigning  this  little  book  to  a  kind  and 
ingenuous  public,  I  make  one  emphatic  protest: 
the  fictitious  persons  here  described  do  not  repre- 
sent actual  individuals.  Dr.  Primrose,  Dr.  Ely, 
Dr.  James,  Dr.  Flaxman,  Dr.  Consequence,  Scho- 
lasticus,  Scriba,  and  the  rest  have  no  true  proto- 
types. They  are  composite  studies.  There  is  one 
exception :  Dr.  Optimus  (chapter  vi)  is  that  remark- 
able man.  Dr.  Edward  Fitch  Gushing,  of  Cleve- 
land, and  my  very  dear  friend,  now  dead. 

Actual  public  and  historical  characters  are  not 
disguised,  but  are  truly  named  in  the  text. 

J.  G.  M. 


CONTENTS 


I.  The  Doctor's  Habitat 
II.  Doctor  and  Patient  —  I 

III.  Doctor  and  Patient  —  II    . 

IV.  Some  Doctors  and  their  Troubles 
V.  Dr.  Primrose  on  Women 

VI.  The  Doctor  is  a  Patient    .       . 
VII.  Dr.  Primrose  on  Socialism  . 
VIII.  Reflections  —  Ambrose  Pare     . 
IX.  Hospital  Talk        .... 

X.  Reminiscences 

XI.  A  Letter  from  Scriba  to  his  Son 


I 

.  20 
.  41 

.  67 

.  95 

•  "5 

• 

.  140 
.  160 
.  200 
.  222 
.  245 


A  Doctor's   liable   "Talk 

CHAPTER  I 

The  Doctor's  Habitat 

My  friend  Dr.  Myers  does  not  live  in  the  town  of 
which  I  approved,  for  he  is  happily  indifferent  to 
his  surroundings,  as  well  as  to  the  canons  of  good 
taste.  Should  you  drive  from  Concord,  Massa- 
chusetts, to  Milton,  you  may,  if  you  choose,  travel 
for  half  a  mile  or  more  on  a  vast  road  which  the 
admiring  natives  call  a  "boulevard."  It  is  very 
wide;  it  bounds  nothing;  it  leads  nowhere;  stretches 
of  unimproved  land  surround  it  —  with  sand-pits, 
forlorn  spaces,  goat-ranges  and  tin-can  depositories. 
In  the  midst  of  the  boulevard  runs  a  double  trolley 
line  —  the  gibbet-like  posts  stretching  oiF  in  a 
straight,  meaningless  perspective.  Parallel  drives 
on  either  side  of  the  rails  bear  countless  motor-cars, 
with  sad  occupants,  —  speeding  voiceless;  while 
rarely  a  gloomy  horse  drags  forth  a  Sunday  van. 


A  Doctor* s  Table  Talk 


The  region  is  inhabited.  For  miles  on  either  side 
stand  rows  of  wooden  houses,  —  "villa  apart- 
ments," they  are  called,  —  garish,  ornate,  tall, 
shapeless,  with  countless  piazzas  and  balconies, 
cupolas,  bow-windows,  and  unnamed  bizarre  pro- 
jections; of  many  colors :  pink  houses,  green  houses, 
purple  houses,  yellow  houses;  houses  of  strange 
design,  striped  and  starred  and  squared.  People 
live  therein.  Late  on  a  summer's  afternoon,  as 
you  drive  past,  you  will  see  weary  fat  men,  in 
shirt-sleeves,  rocking  on  the  balconies,  smoking 
cigars,  and  gazing  solemnly  at  the  tin  cans  below. 
Stout,  black-haired  women  rock  with  them,  and 
pursue  a  ceaseless  knitting.  Listless,  unhealthy 
children  throng  the  gutters,  or  whine  unnoticed 
from  open  windows. 

It  is  a  dreary  company;  but  it  swarms  with  in- 
crease, and  doctors  are  in  demand.  Into  the  midst 
of  these  people  young  Myers  made  his  way,  and 
among  them  he  settled  to  the  practice  of  his  art. 

He  was  right,  and  I  was  wrong.  That  settling 
of  his  took  place  ten  years  ago,  and  now  he  rules 
the  region  with  a  kindly  sway.  He  lives  in  a  great 
pink  house,  which  he  owns.  He  is  happily  married 
and  a  busy  father.  He  has  learned  to  sit  inarticu- 


The  Doctor^ s  Habitat 


late,  with  others  of  his  kind,  on  a  summer  evening, 
mysteriously  exchanging  views  of  neighborhood 
interest.  Rarely,  I,  too,  have  been  admitted  to 
these  solemnities.  Dr.  Myers  has  called  me  in 
consultation;  I  have  sat  in  the  midst  of  his  patients; 
I  have  dropped  feeble  words  of  advice,  and  have 
gained  their  mild  good  will.  My  friend  tells  me 
that,  for  himself,  he  is  satisfied;  that  he  has  found 
his  place.  Happy  man;  thrice  blessed  of  the  gods; 
Deo  favente,  indeed. 

To  most  of  us  that  question  of  where  to  settle  is 
a  mighty  problem.  For  many  years  my  student 
friends,  about  to  leave  the  hospital,  and  seek  an 
establishment,  have  consulted  me  regarding  their 
plans,  and  each  man's  problem  contains  new  and 
difficult  features.  The  bald  question,  "Where  shall 
I  locate?"  which  the  young  doctor  confidently 
asks,  regardless  of  the  English  language,  admits  of 
no  simple  answer.  In  his  problem  there  are  several 
items  of  which  I  want  to  know.  Nowadays  these 
young  men  are  not  products  of  a  single  mill.  Some 
of  them  are  trained  as  surgeons;  others  as  intern- 
ists. Some  wish  to  specialize  more  narrowly;  some 
few  would  fain  be  general  practitioners.  Some 
long  for  a  country  life;  others  fcr  city  practice; 


A  Doctor^ s  Table  Talk 


some  turn  to  the  army  or  navy;  while  others,  again, 
care  not  what  they  do  so  long  as  they  get  promptly 
to  work  and  make  a  living,  for  there  is  a  girl  in 
port,  and  they  would  marry  and  be  happy,  — 
good  human  souls.  And  yet,  mostly,  the  talk  and 
the  planning  and  the  beating  of  heads  is  as  naught. 
It's  the  man  that  counts,  and  not  the  place.  Every 
large  city  among  us  abounds  in  sons  of  successful 
physicians.  The  father's  fame  is  not  transferred 
The  son  rises  or  falls  like  the  rest  of  his  kind.  For 
years  Robert  Koch  was  an  unknown  country  doc- 
tor in  Wollstein.  One  of  the  best-known  surgeons 
in  New  York  City  to-day  was  an  "upstate"  lad 
without  influence  or  acquaintance;  and  the  most 
popular  surgeon  in  Boston  was  a  country  boy  who 
hewed  his  own  way.  In  a  small  Northwestern  vil- 
lage, far  from  the  haunts  of  men,  there  flourishes  a 
little  company  of  surgeons  and  physicians  whose 
work  has  made  them  famous  the  world  over.  How- 
ever, for  the  average  man  of  moderate  attainments 
and  commonplace  ambition,  doubtless  the  location 
counts.  Oliver  Wendell  Holmes  advised  such  to 
open  an  office  in  the  most  conspicuous  house  on 
Beacon  Street,  and  trust  to  luck. 

If  a  man  who  has  not  had  the  advantage  of  a 


The  Doctor^ s  Habitat 


residentship  in  a  great  hospital  wishes  to  devote 
himself  to  surgery,  he  may  choose  one  of  two 
courses:  assuming  that  he  has  a  little  money  to 
carry  him  on  for  a  few  years,  let  him  settle  down 
quietly  in  the  city  of  his  choice,  among  congenial 
surroundings ;  seek  opportunities  for  research  work 
in  laboratories,  clinics,  and  libraries;  bide  his  time, 
take  what  comes  his  way,  and  learn  something,  of 
his  kind  as  stray  samples  of  humanity  drift  past 
him.  Or,  secondly,  if  he  have  true  ambition  and 
a  wish  to  strike  early  and  deep  into  the  surgical 
field,  knowing  himself,  perhaps,  and  his  limitations, 
let  him  cut  loose  from  timid  hoverings  about  old 
haunts;  let  him,  while  still  young,  go  out  boldly 
into  some  of  those  new  regions  in  which  our  coun- 
try abounds.  There  let  him  grow  up  with  the 
place,  stimulated  by  his  new  opportunities,  and 
expanding  broadly  and  generously  with  the  vigor- 
ous life  about  him.  In  five  years  he  will  smile 
with  pity  at  his  mild  colleagues,  clinging  to  that 
conventional  community,  the  dust  of  which  he 
himself  has  shaken  from  his  feet.  If  I  were  again 
and  now  beginning  the  surgeon's  life,  such  adven- 
turing would  be  my  course. 

Perhaps  a  majority  of  the  physicians  in  our  land 


A  Doctor^ s  Table  Talk 


live  in  small  cities  and  towns  of  established  size 
and  considerable  age.  Such  communities  should 
be  sought  out  far  more  commonly  by  our  best- 
trained  young  men.  At  present  jealousy  and  pro- 
fessional backbiting  are  unhappily  prevalent  in 
many  of  these  places ;  but  if  a  man  in  such  a  town 
can  command  his  soul,  his  temper,  and  his  tongue, 
he  will  live  down  envy,  hatred,  and  malice  before 
long,  and  will  find  his  lines  to  be  laid  in  very 
pleasant  places.  If  he  is  trained  properly  in  a 
specialty,  let  him  cling  to  that  specialty  and  so 
increase  the  number  of  his  friends  in  the  profession. 
A  common  cause  of  professional  bad  blood  in  small 
cities  is  the  custom  among  some  of  their  general 
practitioners  of  holding  themselves  out  as  experts 
in  a  specialty.  That  is  a  bad  combination.  Other 
general  practitioners  protest,  and  refuse  to  send 
them  special  cases.  The  genuine  specialists  protest, 
and  regard  them  as  hybrid  humbugs.  In  these 
places  of  moderate  size,  however,  is  to  be  found  a 
good  living,  a  pleasant  and  satisfying  life,  and  fame 
if  our  hero  is  worthy. 

Then  there  is  the  hona-fide  country  doctor. 
Truly,  if  he  be  a  man  of  education,  culture,  appre- 
ciation, and  devotion,  his  life  may  well  be  the 


The  Doctor's  Habitat 


happiest  of  all.  The  other  day,  my  friend  Dr. 
Primrose,  a  physician  in  a  mountain  village  of  New 
Hampshire,  said  to  me:  "I  never  could  understand 
why  you  men  settle  down  in  the  cities.  The  best 
years  of  your  lives  you  spend  on  the  rack,  working 
yourselves  to  death  to  get  practice;  and  later, 
when  you're  established  in  heavy  practice,  you 
find  you've  forgotten  everything  else;  and  you 
grind  away  at  the  dreary  routine  until  you  drop. 
For  me,  —  I  live.  Life  is  very  pleasant.  I  pass 
my  time  in  a  beautiful  country  and  in  healthful 
surroundings.  I  am  always  with  nature.  I  have 
time  to  know  and  enjoy  my  wife  and  children;  I 
have  enough  work  to  keep  me  busy,  contented, 
and  reasonably  prosperous,  but  not  so  much  as-  to 
wear  me  out.  I  can  read  and  think  and  travel.  You 
men  struggle  and  succeed,  and  then  half  of  you 
collapse."  In  some  measure  he  is  correct ;  and  cheer- 
ful are  the  days  I  pass  with  this  kindly  philosopher. 
Sometimes,  of  a  summer  midnight  we've  driven 
out  together,  —  a  silent  and  happy  time  for  a  man 
of  feeling.  The  shadows  fall  from  the  hillside;  the 
sounds  of  country  night  mingle  in  drowsy  harmony; 
in  the  distance  a  dog  barks;  the  moonlight  sifts 
flickering  through  the  leaves,  and  the  dusky  road 


8  A  Doctor's  Table  Talk 

lies  dimly  undefined.  At  our  feet,  as  we  jog  round 
a  curve,  the  waters  of  the  lake  lap  gently  the  con- 
stant shore;  a  tree  toad,  unceasing,  sings  his  song; 
the  wind  sighs  among  pastured  elms,  obscure, 
remote;  mist  settles  on  the  face  of  the  waters. 
Overhead  the  stars  sing  together  in  their  courses, 
the  moon  presides  with  gentle  radiance  over  all. 
The  dawn  begins  to  break.  Far  away  a  cock  crows 
on  a  hilltop ;  and  now,  at  our  feet,  from  the  valley 
a  voice  replies.  A  mist  rises  about  us;  the  air  is 
chill.  Infrequent  lights  appear  on  distant  slopes; 
the  chirp  of  birds  is  heard, —  scattered,  at  first;  un- 
certain, faint;  then,  gathering  strength,  —  constant, 
sustained,  soaring  in  mingled  choir.  Rocks,  trees, 
and  shrubs  take  form;  the  way  grows  clear;  a 
mountain-top  glows  in  the  rising  sun.  We  climb 
an  upper  road,  circling  the  hill.  The  morning  wind 
blows  fresh  upon  our  eyes.  A  battered  house 
stands  close  against  the  trail;  the  old  horse  stops. 
Such  are  some  of  the  errands  of  Primrose,  the 
country  doctor;  it  is  the  life  he  loves;  the  poet  often 
illustrates  the  man.  Doubtless  he  is  in  some  sense 
right  about  those  of  us  who  toil  ceaselessly  among 
men.  Against  us  he  quotes  Stevenson's  delightful 
words:  "Extreme  busyness,  whether  at  school  or 


The  Doctor's  Habitat 


college,  kirk  or  market,  is  a  symptom  of  deficient 
vitality;  and  a  faculty  for  idleness  implies  a  catho- 
lic appetite  and  a  strong  sense  of  personal  identity. 
There  is  a  sort  of  dead-alive,  hackneyed  people 
about,  who  are  scarcely  conscious  of  living  except 
in  the  exercise  of  some  conventional  occupation. 
Bring  these  fellows  into  the  country,  or  set  them 
aboard  ship,  and  you  will  see  how  they  pine  for 
their  desk  or  their  study.  They  have  no  curiosity; 
they  cannot  give  themselves  over  to  random  provo- 
cations; they  do  not  take  pleasure  in  the  exercise 
of  their  faculties  for  its  own  sake;  and  unless 
Necessity  lays  about  them  with  a  stick,  they  will 
even  stand  still.  It  is  no  good  speaking  to  such 
folk;  they  cannot  be  idle;  their  nature  is  not  gener- 
ous enough;  and  they  pass  their  hours  in  a  sort  of 
coma  which  are  not  dedicated  to  furious  moiling 
in  the  gold-mill." 

As  regards  physicians,  such  reflections  are  not 
altogether  fair.  Wherever  they  live,  or  whatever 
their  ambitions,  doctors  rarely  become  rich;  but 
Dr.  Primrose  is  a  man  of  uncompromising  views. 
Almost  the  only  one  among  us  whom  he  truly 
respects  is  the  city  general  practitioner ^  a  rare  man 
in  these  latter  days.  That  is  a  man,  he  will  exclaim, 


lo  A  Doctor's  Table  Talk 

who  attends  to  his  proper  business  —  the  healing  of 
the  sick;  and  he  twirls  his  cigar  and  pulls  at  his 
hair  as  he  strides  up  and  down  my  study.  Then  he 
becomes  personal:  "I  mean  Ely,  Bill  Ely.  He 
promised  well  when  we  were  all  at  the  hospital 
twenty  years  ago.  He  liked  folks,  and  he  knew 
how  to  take  care  of  'em.  He  was  always  on  his  job, 
as  you  say;  and  they  tell  me  he's  on  it  still." 

This  is  all  true  enough;  Ely  has  made  good;  but 
then  Ely  is  a  rare  soul.  He  set  up  an  office  near  me 
when  he  began  practice,  and  I  have  seen  his  daily 
work  ever  since.  He  looked  towards  general  medi- 
cine (they  call  such  men  "internists"  nowadays), 
while  I  looked  towards  surgery.  To  a  wide  experi- 
ence he  united  learning  and  courage.  He  has  suc- 
ceeded beyond  his  earliest  dreams;  but  then  he 
hungers  for  work,  and  depends  on  no  location. 
The  sick  and  unfortunate  seek  him.  He  belongs 
to  that  old  school  of  practitioners  who  believe  in 
the  doctor's  personal  influence  and  contact.  He 
loathes  the  modern  notion  of  a  mechanical  practice 
which  depends  solely  on  steam,  serum,  and  test- 
tubes,  but  disregards  personality,  wisdom,  sanity, 
and  friendliness  in  the  family  physician.  Once  a 
year  he  and  Primrose  come  together  at  my  table 


The  Doctor* s  Habitat  1 1 

to  exchange  and  refresh  their  views,  —  EI7  all 
sympathy  and  encouragement;  Primrose  flashing 
philippics  and  thirsting  for  reform. 

As  Primrose  says,  Ely  has  certainly  made  good. 
To  be  sure,  Ely  went  about  his  business  from  the 
first  in  the  old-fashioned  way;  but  In  considerable 
measure  that  is  what  people  still  want;  and  later 
you  shall  hear  the  two  men  arguing  the  relative 
advantages  of  the  old  and  the  new.  Beyond  per- 
adventure,  Ely  has  succeeded  by  his  untiring 
devotion  to  clinical  medicine.  He  consults  detail. 
When  he  opened  his  first  office  and  installed  one 
of  the  early  telephones,  he  saw  to  it  that  that  tele- 
phone was  always  intelligently  answered.  Think 
how  the  ordinary  telephone  is  answered,  he  would 
lament.  Some  fool  takes  down  the  receiver  and 
says,  "Well;  what  do  you  want.?  No;  I  can't  tell 
you  when  he'll  come  in.  Call  up  whom.?  —  what 
name.?  Murdock.?  Murphy?  Mumpy?  Well,  spell 
it.  Oh,  Carter.  Yes,  I'll  tell  him";  and  then  she 
goes  upon  her  gadding  way,  diligently  forgetful  of 
the  message. 

"Fancy  the  Indignation  of  poor  Mrs.  Carter," 
groans  our  friend.  "  When  you  call  a  doctor,  you  're 
in  pain  or  trouble.  You  want  him.  You  don't  want 


12  A  Doctor's  Table  Talk 

to  gossip.  You  mean  business;  and  that's  what  the 
average  servant  does  n't  seem  to  understand." 

So  Ely  imposed  an  invariable  standard  reply  to 
telephone  calls,  in  case  he  was  not  at  home:  "No; 
Dr.  Ely  is  not  in;  but  I  can  get  him  for  you  in  a 
few  minutes.  What  is  your  number.''  He  will  call 
you."  Only  last  week  I  had  occasion  to  telephone 
him,  when  I  received  that  same  familiar  reply 
which  his  office  attendant  has  been  sending  out 
these  twenty  years.  It  must  have  secured  to  him 
countless  friends  and  thousands  of  dollars  in  all 
this  time. 

Such  methods  are  sometimes  called  "tricks  of 
practice"  by  the  fools  and  the  faithless  among  his 
contemporaries  and  rivals,  but  Ely  has  something 
better  than  tricks  of  practice  to  offer  his  patients. 
I  have  said  that  he  has  knowledge  and  ability.  He 
began  by  studying  the  habits  of  his  community. 
He  observed  that  great  numbers  of  prospective 
patients  deserted  the  city  every  year  during  the 
summer  and  autumn  months,  migrating  to  such 
seaside  places  as  Atlantic  City,  Beverly,  and  New- 
port. So  he  followed  them.  One  prosperous  sum- 
mer he  spent  in  Saunderstown,  near  Newport;  then, 
the  next  year,  encouraged  by  success,  he  descended 


The  Doctor's  Habitat  13 

boldly  upon  Newport  Itself,  where  he  was  soon 
appreciated  and  properly  valued.  Now  for  eighteen 
years  he  has  spent  his  time  between  Newport  and 
his  home  city.  He  has  made  those  two  communi- 
ties call  for  him  and  respect  him  because  he  has 
cherished  his  patients  in  the  old-time  manner,  and 
has  made  their  troubles  his  own. 

This  means  a  generous  and  sincere  love  of  his 
kind.  Such  love  is  a  quality  that  grows  with  a 
man's  growth.  It  cannot  be  aped  and  cultivated. 
It  cannot  be  imitated  successfully  for  eighteen 
years.  Ely  follows  his  patients.  He  coordinates 
the  generations.  From  the  cradle  to  the  grave 
whole  families  hang  upon  him.  He  cares  for  the 
babies  in  their  growings-up  until  they  have  babies 
of  their  own.  He  is  a  storehouse  of  strange  family 
histories  and  appropriate  wisdom. 

One  day,  perplexed  and  indignant.  Dr.  Ely  came 
to  me  to  talk  over  one  of  his  problems,  which  he 
called  "The  Folly  of  the  Vanderpoels."  He  had 
known  the  Vanderpoels  for  some  ten  years  only. 
He  called  them  one  of  his  new  families.  They  fol- 
lowed him  from  Newport.  At  the  time  of  their 
first  coming  there  was  a  cheerful,  sparkling  father, 
a  joyous  man  of  middle  age,  immersed  in  carnival 


14  A  Doctor's  Table  Talk 

habits.  There  was  a  high-hearted  mother,  giving 
herself  wholly  to  her  many  children.  There  were 
two  sons  and  four  daughters,  of  whom  Ellen  was 
the  youngest.  They  took  a  big  house,  spent  more 
money  than  they  should,  and  then,  shortly,  the 
joyous  father  fell  a  victim  to  typhoid  fever  and 
died.  Ellen,  our  heroine,  was  fourteen,  a  shy,  seri- 
ous child  —  always  buried  in  her  book,  or  by  the. 
hour  long  practicing  her  violin.  For  the  winter 
after  Mr.  Vanderpoel's  death,  the  mother,  with  her 
girls,  went  to  Europe,  where  they  spent  most  of 
their  time  during  some  years,  returning  home  for  a 
month  or  two  only  every  summer. 

"Now,"  said  Ely,  "you  must  suppose  that  sun- 
dry chee^rful  American  girls,  turned  loose  in  sundry 
German  watering-places,  will  attract  a  certain 
amount  of  attention.  And  of  course  our  Vander- 
poel  girls  have  had  their  heads  turned  by  those 
insufferable  German  and  Austrian  officers.  What 
should  happen  but  that  our  little  friend  Ellen,  now 
a  twenty-year-old  beauty,  must  fall  in  love  with 
some  brass  buttons,  a  sword  and  a  mustache. 
The  cub  seems  to  be  a  decent  enough  cub,  for  he 
reciprocates,  and  the  two  have  been  planning 
matrimony;  —  she's  been  at  home  the  past  two 


The  Doctor's  Habitat  15 

months  buying  stockings  and  other  wedding  gar- 
ments. 

"In  the  mean  time  her  officer,  a  captain  in  a 
royal  guard  regiment,  or  something  that  sounds 
like  it,  has  been  having  the  deuce  of  a  time  getting 
permission  to  marry.  It  seems  that  the  officers  in 
certain  Austrian  regiments  must  not  marry  for- 
eigners. So  this  poor  fellow  has  been  having  a 
bad  time  of  it;  but  finally,  through  family  and 
court  influence  he  has  secured  a  special  permit  and 
absolution  from  the  Emperor  himself  to  marry  our 
friend  Ellen.  So  he's  temporarily  shed  his  brass 
buttons,  concealed  his  sword  in  his  trunk,  clothed 
himself  in  the  unbecoming  garments  of  a  Viennese 
civilian,  and  will  arrive  here  to-night  at  eight 
o'clock  to  claim  his  bride;  —  and  what  do  you 
suppose  she  is  doing.'*  She's  locked  the  door  of  her 
room  —  taking  care  to  leave  open  the  communi- 
cating door  of  her  sister's  room;  she's  gone  to  bed 
in  hysterics;  she  sobs  that  she  'hates  the  shape  of 
her  captain's  nose,  that  she  will  not  see  him,  and 
that  she'll  never,  never,  never  marry  him.'" 

So  they  sent  for  poor  Ely,  and  begged  him  to 
persuade  the  girl  to  decency  and  her  duty.  But 
his  interference  was  of  no  use;  of  course  it  was  of 


1 6  A  Doctor'' s  Table  Talk 

no  use,  as  Ely  told  them  before  he  began  his  task. 
His  heart  was  not  in  it.  For  all  he  knew,  Ellen 
was  right.  He  handed  her  the  usual  platitudes, 
describing  the  humiliation  of  her  family  and  the 
shock  and  misery  of  the  insulted  Austrian.  It  was 
hopeless;  —  she  turned  her  face  to  the  wall,  refused 
to  argue,  and  sobbed  out  at  intervals,  "I  can't 
help  it;  I  hate  him,  I  hate  him,  and  I'll  never 
marry  him."  And  she  kept  her  word.  A  brother 
and  a  sister  met  the  poor,  unsuspecting,  smiling 
wretch  at  the  train,  and  told  him  his  fate.  He 
refused  to  believe  them,  of  course.  He  stayed  in 
town  for  a  week,  trying  to  get  speech  of  his  be- 
loved, but  in  vain.  He  haunted  her  house  for  days, 
taxing  the  patience  and  vocabulary  of  mother, 
brothers,  and  sisters;  he  even  discovered  poor  Ely, 
and  drove  with  him  for  hours,  exhausting  his  sym- 
pathy and  his  most  cherished  German  idioms.  He 
refused  food  and  comfort,  he  lived  on  beer  and 
cigarettes,  he  began  to  cultivate  a  wild  disorder 
of  whisker  about  his  foolish  countenance;  and  at 
last,  amid  a  deluge  of  tears,  and  sighs  of  Vander- 
poel  relief,  he  was  led  away  to  Vienna  by  poor 
Ellen's  distracted  eldest  brother.  That  good  soul 
never  left  him  until  he  had  delivered  him  safely  at 


The  Doctor* s  Habitat  Vj 

his  barracks,  when  he  himself  escaped  to  Paris  for 
a  two  weeks'  convalescence.  What  became  of  the 
broken-hearted  lover  Ely  never  heard;  but  one 
imagines  the  Gargantuan  applause  of  his  comrades 
when  they  heard  his  tale;  the  anger  and  mortifica- 
tion of  his  superiors;  and  the  avidity  with  which 
poor  Fritz  sought  the  consolation  and  sympathy 
of  some  kindly  neighborhood  Gretchen. 

"And  the  worst  of  it  all  was,"  said  my  indignant 
friend,  as  he  told  me  the  completed  story,  long 
afterward,  "that,  in  spite  of  my  silence  and  utmost 
effort  to  keep  the  affair  quiet,  some  confounded 
reporter  nosed  it  out,  and,  two  days  after  the  cap- 
tain had  left  for  home,  told  the  whole  yarn,  ex- 
actly as  it  occurred,  names  and  all,  in  one  of  the 
Sunday  papers."  The  exposure  was  too  much  for 
human  endurance.  The  family  left  town,  and  have 
never  returned. 

Perhaps  I  have  gone  out  of  my  way  and  have 
wandered  from  our  subject  in  telling  this  episode  of 
the  Vanderpoels.  It  illustrates,  however,  the  variety 
of  a  physician's  problems.  Ely  sometimes  refers  to 
it  in  our  discussions,  and  I  think  he  still  regards  it 
as  one  of  the  most  difficult  of  the  social  and  psy- 
chical phenomena  with  which  he  has  had  to  deal. 


i8  A  Doctor's  Table  Talk 

Of  all  my  friends  among  physicians,  however,  I 
turn  most  often  to  Dr.  Primrose,  when  I  look  for 
detached  views  and  a  wide  perspective.  "To  go 
back  to  your  original  question,"  he  says,  "let  me 
observe  that  in  the  main  I  agree  with  you  about 
localities,  though  what  you  state  is  true  of  all  men 
in  all  vocations.  I  know  many  doctors,  from  Port- 
land, Maine,  to  Portland,  Oregon;  and  from  Mon- 
treal to  San  Antonio.  I  attend  their  annual  meet- 
ings; I  like  them.  The  able  and  efficient  always 
make  themselves  felt.  Their  location  has  little  to  do 
with  their  success.  I've  come  to  the  conclusion 
that  the  second-raters  and  the  lame  ducks  are  the 
fellows  most  particular  about  their  place  of  abode. 
Yet,  after  all,  did  it  ever  occur  to  you  that  the' 
second-raters  are  doing  most  of  the  work  of  the 
world  ?  Few  of  us  can  be  leaders.  Most  of  us  must 
get  down  into  the  pit,  and  grind  faithfully  at  the 
mill,  without  hope  of  distinguished  reward.  To 
most  of  us,  then,  the  question  of  location  matters, 
but  only  in  so  far  as  it  concerns  competition.  With- 
out rivals  we  get  along  more  comfortably  —  com- 
petition stimulates  the  elect,  the  leaders;  it  dis- 
courages the  rest  of  us.  After  all,  given  a  good 
education  and  some  experience,  faithful  service  is 


The  Doctor's  Habitat  19 

what  brings  success  to  the  average  doctor;  and  I 
don't  care  where  he  serves.  I'm  old-fashioned 
enough,"  he  adds,  "to  believe  in  the  golden  rule, 
good  ethics,  and  a  square  deal.  It  does  us  no  harm, 
too,  to  reflect  sometimes  on  those  fine  old  words  of 
the  Psalmist:  'Blessed  is  the  man  that  walketh  not 
in  the  counsel  of  the  ungodly,  nor  standeth  in  the 
way  of  sinners,  nor  sitteth  in  the  seat  of  the  scorn- 
ful. But  his  delight  is  in  the  law  of  the  Lord ;  and 
in  his  law  doth  he  meditate  day  and  night.' " 


CHAPTER  II 
Doctor  and  Patient — / 

Dr.  Primrose,  from  the  New  Hampshire  hills, 
and  Dr.  Ely,  from  Madison  Street,  met  at  my  house 
the  other  night  for  one  of  our  annual  dinner  talks 
on  medical  topics  and  life  in  general.  Both  my 
friends  were  at  their  best,  and  kept  the  ladies  long 
at  the  table.  Primrose  held  forth  for  a  time  on 
present-day  teaching  in  the  universities;  and  the 
educators,  as  the  newspapers  call  them,  came  in  for 
their  usual  drubbing. 

"But  so  many  of  our  harsh  criticisms  are  true," 
he  said.  "The  college  corporations  are  lavishing 
money  on  buildings  and  flower-beds,  while  the 
real  teachers  are  starving;  and  untrained  boys  are 
set  over  the  students  in  the  classrooms.  Here's  a 
yarn  a  freshman  friend  of  mine  told  me  last  night. 
It  appears  that  the  ambitious  fellow  has  elected  a 
Greek  course.  His  class  of  twenty  are  reading  the 
Odyssey.  Now,  you  will  admit,  Ely,  that  that  gives 
an  unusual  chance  for  the  real  teacher  in  these 
hard-headed  days ;  that  is  a  very  great  poem,  little 


Doctor  and  Patient  21 

read  of  late,  about  which  old  custom  and  tradition 
have  grouped  a  vast  library  of  some  of  the  most 
interesting  criticism  in  the  world's  literature. 
Think  what  the  Odyssey  has  stood  for  these  three 
thousand  years,  to  the  peoples  and  the  poets  of  the 
world. 

"So  I  said  to  my  freshman  friend,  *Good;  that's 
splendid.  It's  the  literature  of  the  gods.  Isn't 
your  instructor  delighted  to  have  so  large  a  class 
this  year?  Does  he  give  you  some  of  his  own 
enthusiasm?' 

"'Well;  no,  sir,'  says  my  friend,  with  a  grin;  *his 
principal  interest  is  to  find  out  how  much  we  use 
trots.'" 

"I  know,  I  know,"  said  Ely,  with  a  sad  shake 
of  the  head.  He  himself  is  an  overseer  of  his  uni- 
versity. "There's  no  doubt  that  the  fundamental 
trouble  is  with  our  governing  boards ;  but  consider 
how  difficult,  or  almost  impossible,  it  is  to  find 
university  governors  or  trustees  who  are  trained 
for  their  job.  They  are  business  and  professional 
men,  who  are  important  in  their  communities. 
They  are  chosen  governors  because  they  are  im- 
portant; but  they  are  immersed  mostly  in  their 
own  affairs.    They  know  nothing,  at  first,  about 


22  A  Doctor's  Table  Talk 

the  conduct  of  great  or  small  university  matters; 
and,  even  later,  they  rarely  succeed  in  handling 
those  affairs  to  the  best  advantage,  except  in  the 
case  of  the  investment  and  expenditure  of  money." 

"Yes,  yes,"  quoth  Primrose;  "and  I  know  that 
the  true  teacher  is  a  rare  man,  a  gift  of  God,  indeed. 
How  many  real  teachers  had  you?  I  knew  two. 
One  was  the  great  head  master  of  our  old  school; 
the  other  was  a  college  professor.  In  the  medical 
school  we  had  no  great,  informing,  and  stimulating 
teachers,  as  we  should  have  had." 

My  companions  sat  silent  for  a  time,  wagging 
their  heads  over  the  lamentable  situation. 

Said  Ely;  "Our  best  medical  schools  are  run  too 
exclusively  for  the  race-horses.  The  average  man 
does  n't  get  enough  mental  stimulation,  or  practical 
advice  about  how  to  make  his  living.  I  see  the 
results  constantly  among  my  younger  consultants 
who  come  to  me  for  help  and  direction.  And  then 
there  is  that  protest  which  the  doctors  are  raising 
throughout  the  land:  'What's  the  matter  with 
practice  }  Have  the  people  lost  confidence  in  medi- 
cine?'" 

"About  that  last  question  —  the  attitude  of  the 
public,"  remarked  Primrose,  "I  have  a  word  to 


Doctor  and  Patient  23 

say,  though  I  cannot  pretend,  in  a  sentence,  to 
clear  up  a  most  complex  situation.  The  puzzled 
uncertainty  of  the  public  and  their  rather  irritating 
skepticism  should  not  surprise  us.  The  academic 
explanations  of  our  sundry  theorists  —  that  we 
are  inefficient,  that  our  standards  of  education  are 
uncertain,  etc.,  etc.  —  are  mostly  rubbish.  A  hun- 
dred years  ago,  when  we  were  far  less  efficient  and 
well  trained,  the  public  trusted  us  with  little  ques- 
tion. 

"The  fact  Is,  our  professional  fathers  and  grand- 
fathers, back  to  the  five  hundredth  generation  and 
earlier,  persistently  fooled  the  public.  Our  genera- 
tion has,  quite  properly,  attempted  to  reverse  the 
practice  and  tradition  of  the  ages,  by  taking  the 
public  into  its  confidence,  and  attempting  to  discuss 
with  the  public  our  scientific  problems.  You  can- 
not blame  the  fathers  for  their  methods.  Humbug 
and  tomfoolery  were  much  of  the  stock  in  trade  of 
the  priests,  wizards,  and  medicine-men  from  whom 
we  are  descended.  The  same  was  true  of  all  pre- 
tenders to  knowledge.  Throughout  history,  you 
will  find  the  man  who  knows  some  one  thing  a  little 
better  than  his  neighbors  making  a  mystery  of  ft, 
and  trading  on  his  possession.    The  history  of 


24  A  Doctor'' s  Table  Talk 

religion  shows  the  same  tendency  among  bigots.  A 
few  great  souls  only  have  withstood  the  temptation. 
Our  doctors,  even  fifty  years  ago,  were  walking  in  a 
maze  of  uncertainty  and  puzzlement.  Only  after 
Virchow,  Pasteur,  Koch,  and  a  few  others  showed 
us  the  nature  of  disease,  did  we  begin  confidently 
to  plant  our  feet  on  firm  ground.  But  the  public 
don't  understand  all  that.  They  are  looking  al- 
ways for  Immediate  results.  They  persist  in  think- 
ing that  medicine  is  an  exact  science,  as  much  as 
algebra;  and  we  cannot  make  them  see  that  it  must 
be  compared  rather  with  farming  or  gardening. 

"Now  we  have  come  out  in  the  open,  and  are 
trying  to  tell  the  public  what  we  are  doing  and 
attempting.  They  cannot  or  will  not  understand 
us.  They're  always  looking  for  some  underhand 
dealing  or  concealed  meaning.  Through  their  own 
ignorance,  or  lack  of  careful  training,  they  fail 
utterly  to  comprehend  our  accurate,  critical,  scien- 
tific attitude  of  mind.  Thank  God ;  there  are  a  few 
great  exceptions,  —  the  Hannas,  the  Rockefellers, 
theCarnegies  and  the  Morgans.  As  Ewing^  said  the 

*  Professor  James  Ewing,  "  The  Public  and  the  Medical  Pro- 
fession." Address  before  the  New  York  Academy  of  Medicine, 
November  i6,  191 1. 


Doctor  and  Patient  25 

other  day  in  his  talk  at  the  Academy  of  Medicine, 
and  I  read  it  from  this  journal  —  lack  of  public 
sympathy  with  the  medical  profession  *is  seen  in 
the  crude  and  halting  manner  in  which  medical 
topics  are  handled  by  distinguished  writers,  clergy- 
men, lawyers,  statesmen,  and  public  officials.  The 
efforts  of  the  daily  press  to  furnish  Information  on. 
medical  topics  consist  of  sensationalism,  person- 
alities, wonder  tales,  absurdities.  The  National 
Government,  however,  has  at  last  awakened  to  the 
necessity  of  a  National  Bureau  of  Health,  such  as 
has  long  existed  In  other  countries.  Yet,  instead  of 
going  ahead  with  it,  we  have  the  astonishing  spec- 
tacle of  the  President  of  the  United  States  holding 
a  public  hearing  to  debate  the  question.'  Let  so 
much  stand  for  my  present  contribution  to  this 
very  difficult  subject,  which  has  troubled  me 
much." 

"Fundamentals  and  panaceas  are,  of  course,  the 
most  interesting  subjects  for  discussion,"  Ely  re- 
marked; "but  my  younger  friends  ask  me  for  some 
practical  means  of  improving  their  incomes.  I  tell 
them,  first  of  all,  to  get  and  read  carefully  James 
Jackson's  'Letters  to  a  Young  Physician,'  and  then 
I  talk  over  with  them  the  dozen  or  more  important 


26  A  Doctor'' s  Table  Talk 

details  of  practice,  which  we  learn  by  a  hard 
experience  only. 

"So  long  as  we  have  started  on  this  rather 
technical  subject,  let's  explore  it  further.  It's 
interesting,  and  you  can  help  me.  Just  to  show 
you  what  inane  things  a  recent  graduate  may  do: 
I  met  this  morning  my  very  good  friend  John 
Strong.  Now,  Strong  is  an  important  man,  whose 
name  goes  a  long  way  in  this  community.  His 
family  are  not  regular  patients  of  mine.  It  seems 
that  last  night  one  of  his  children  developed  what 
their  trained  nurse  took  to  be  diphtheria.  Strong 
went  in  great  haste,  about  one  in  the  morning,  for 
young  Hamblen  in  his  neighborhood,  whom,  as  a 
competent  general  practitioner,  I  had  recom- 
mended to  him;  and  what  do  you  suppose  Hamblen 
did  t  He  informed  Strong  that  he  could  not  see  the 
patient,  as  he  does  not  take  cases  of  diphtheria. 
Of  course  Strong  was  furious.  He  went  home  and 
telephoned  to  me;  I  went  over  there,  took  cultures, 
and  turned  the  case  over  to  my  assistant.  I  don't 
think  it  is  diphtheria. 

"This  morning  I  had  a  pleasant  talk  with  that 
young  donkey,  Hamblen.  It  seems  he  had  a  notion 
that  he  might  have  some  sort  of  a  surgical  case  this 


Doctor  and  Patient  27 

week.  'Did  you  tell  Mr.  Strong?'  I  asked.  No,  he 
had  not  told  Strong.  At  the  least,  he  might  have 
gone  to  his  patient's  house,  interviewed  the  nurse, 
found  another  doctor  for  the  child,  and  taken  the 
responsibility  off  from  the  parents'  shoulders.  But 
no,  he  could  think  of  nothing  better  to  do  than 
shout,  'No!  No!'  and  slam  the  door.  That  young 
man  was  a  good  undergraduate  student." 

"Your  friend  Strong  has  a  deficient  sense  of 
humor,"  said  Primrose;  "the  other  day  a  doctor 
I  know  told  a  patient  to  close  his  eyes,  put  his 
thumb  to  his  nose,  and  stand  on  one  leg.  As  the 
man  was  leaving  the  office,  he  said  to  the  doctor, 
'Why  did  you  make  me  stand  on  one  leg  and  all 
that  business.?'  'Oh,'  said  the  other,  grinning,  'I 
wanted  to  give  my  small  boy  practice  with  his  new 
camera.'  The  patient  was  a  Hebrew.  He  brought 
suit  against  the  doctor  for  malpractice,  and  recov- 
ered one  hundred  dollars.  He  had  no  sense  of 
humor  either." 

"We  must  not  be  too  hard  on  the  beginners," 
Ely  replied.  "Entirely  aside  from  his  technical 
training,  the  business  of  being  a  doctor  is  difficult, 
intricate,  personal,  and  calls  for  a  very  superior 
form  of  tact  and  sense.  It  is  for  want  of  these  quali- 


28  A  Doctor^ s  Table  Talk 

ties  that  so  many  physicians,  both  men  and  women, 
fail;  and  I  am  not  sure  but  what  the  women  make 
worse  failures  than  the  men.  I  suppose  because 
women,  more  than  men,  are  tenacious  of  their  own 
opinions.  That  sex  element  is  a  curious  thing,  by 
the  way.  Did  you  ever  notice  how  most  women 
nurses  resent  being  under  the  orders  of  women 
doctors?" 

Primrose  seemed  to  agree,  although  he  commonly 
holds  women  and  women's  achievements  in  the 
highest  regard. 

The  discussion  of  practice  by  these  two  men 
leads  me  to  formulate  some  of  the  views  which  I 
have  often  expressed  to  my  younger  friends  in 
their  early  years  of  business.  I  find  that  Ely  in- 
dorses me  in  the  main.  This  discussion  takes  no 
account  of  technical  training.  A  good,  scientific 
training  is  assumed.  We  are  talking  about  the 
more  superficial  aids  to  practice,  with  a  glance, 
perhaps,  at  some  questions  of  ethics  and  etiquette. 

As  the  young  doctor  thinks  of  superficial,  but 
important  aids,  let  him  make  three  divisions  of  his 
problem:  first,  his  own  personal  setting,  —  house, 
office,  and  location;  second,  his  attitude  towards 
patients,  —  his  method,  his  manner,  the  human 


Doctor  and  Patient  29 

relation,  and  his  regard  for  the  individual;  third, 
his  professional  relations,  —  his  associates,  the 
medical  societies  to  which  he  belongs,  his  medico- 
social  activities,  and  his  contributions  to  the  pleas- 
ure and  information  of  his  fellows. 

In  spite  of  what  may  be  said  about  superior  men, 
and  their  success  no  matter  where  they  live,  the 
question  of  location  is  important  to  most  of  us 
average  men.  I  am  not  referring  to  the  broad 
question  of  city,  town,  or  country;  but  —  in  what 
part  of  the  city  or  the  village  shall  the  young 
doctor  open  his  office,  and  hang  out  his  "shingle"? 
The  general  practitioner,  or  the  surgeon,  in  most  of 
our  eastern  American  cities  and  towns,  will  do  well, 
still,  to  appear  to  occupy  his  own  house  and  to  have 
his  office  there;  and  the  more  conspicuous  the  house 
the  better.  In  our  old  communities  the  prejudice 
lingers  that  such  a  combination  of  house  and  busi- 
ness office  marks  a  doctor  as  serious,  conservative, 
and  of  good  morals.  As  for  specialists,  the  old  com- 
munities regard  them,  like  dentists,  as  pariahs, 
as  outside  of  the  rules.  Let  them  go  where  they 
choose,  —  to  hotels  or  apartment  houses  for  their 
offices;  and,  indeed,  they  do  often  abide  in  such 
convenient  places.   In  most  American  cities,  how- 


30  A  Doctor's  Table  Talk 

ever,  —  cities  and  towns  beyond  the  Atlantic  sea- 
board, —  a  much  more  convenient  and  reasonable 
custom  now  prevails.  In  those  places,  the  doctors 
have  learned,  like  lawyers  and  other  professional 
men,  to  keep  separate  their  homes  and  their  busi- 
ness. Quite  commonly,  special  buildings  are  erected 
for  doctors,  or  doctors  group  themselves  in  con- 
verted private  houses,  in  apartment  houses,  in 
hotels,  or  even  in  ordinary  business  blocks.  It 
makes  little  difference  where  they  go  so  long  as 
they  command  easily  those  neighborhoods  in 
which  they  wish  to  find  their  patients.  And 
observe  this,  that  a  doctor  must  be  able  to  live  on 
the  same  financial  scale  as  his  neighbors.  If  he  is 
in  a  tenement  district,  he  may  live  from  hand  to 
AioutH,  as  a  poor  man.  If  he  is  in  a  middle-class 
district,  he  may  live  on  a  small  scale  —  spending 
from  a  thousand  to  fifteen  hundred  a  year;  but  if 
he  is  surrounded  by  well-to-do  or  rich  people,  he 
must  plan  to  spend  money  freely.  His  patients 
among  his  neighbors  will  expect  to  find  in  his  estab- 
lishment an  air  of  circumstance, .  comfort,  and 
proper  distinction,  —  not  necessarily  luxury  and 
extravagance,  but  the  sort  of  thing  they  are  accus- 
tomed tp  see  in  their  own  homes.  Local  conventions 


Doctor  and  Patient  3 1 

have  their  significance  in  special  localities.  The 
city  practitioner  who  makes  his  calls  on  foot  or  by 
trolley  car  may  enjoy  the  confidence  of  his  com- 
munity, and  be  regarded  as  a  prosperous  and  suc- 
cessful personage,  whereas  his  country  brother,  in 
a  neighboring  village,  must  drive  his  horses  or  his 
motor,  if  he  is  not  to  be  thought  a  hopeless  failure. 

Wherever  he  lives,  however,  and  whatever  his 
special  practice,  there  are  certain  features  and 
attributes  of  his  setting  which  no  physician  can 
afford  to  neglect.  A  certain  atmosphere,  a  certain 
air  of  serious  work  and  solid  accomplishment,  a 
tone  of  smartness  combined  with  a  sense  of 
assured  propriety  in  his  house,  his  rooms,  and  their 
furnishing,  not  only  go  a  long  way  towards  giving 
him  an  unconscious  sense  of  security,  but  tend, 
through  a  sort  of  subconscious  impression,  to  steady 
himself,  to  smooth  his  day's  work,  and  to  endow 
him  with  assurance  and  a  feeling  of  professional 
dignity  and  power. 

The  reverse  of  all  this  is  sombre  and  depressing. 
Not  long  ago  I  visited  the  house  of  a  friend  who 
complained  bitterly  of  his  lack  of  patients.  Flax- 
man  is  a  young  man  of  rather  sad  address,  but  well 
educated  for  his  work,  who  lives  in  an  attractive 


32  A  Doctor's  Table  Talk 

city  suburb,  among  people  of  moderate  means, 
small  shopkeepers,  sober  clerks,  and  the  like  —  a 
distinctly  non-stimulating,  bourgeois  atmosphere; 
a  community  to  be  suffered,  —  gladly  or  not,  — 
but  from  which  no  sweetness  or  light  can  be 
expected  to  emanate.  They  cannot  yet  appreciate 
Dr.  Flaxman,  sensitive,  reserved,  unheroic  of 
aspect,  —  a  man  who  would  cut  his  tongue  out 
rather  than  gossip  of  professional  secrets.  But  his 
neighbors  and  clients  complained  of  him  for  other 
reasons,  and  with  some  justice,  as  I  could  see.  I 
drove  to  his  house  in  a  motor,  but  was  unable  to 
dismount  at  his  door,  owing  to  a  dreary  phalanx  of 
disreputable  ash-cans  which  lined  and  obstructed 
the  curb.  After  floundering  in  the  slush  and  ice 
of  the  street,  and  breaking  through  a  dingy  snow- 
bank, I  encountered  Flaxman  on  his  knees,  dis- 
mally breaking  up  the  sidewalk  ice  with  an  incon- 
sequential hatchet.  At  the  sight  of  an  old  friend 
his  expression  changed  instantly.  He  has  a  smile 
of  rare  sweetness  and  sympathy.  As  he  jumped 
up  from  his  dripping  knees,  I  received  his  smile 
full  in  the  eyes,  and  we  shook  hands  warmly.  I 
must  go  into  the  house  at  once  and  get  dry,  he 
ordered.   He  himself  would  be  in,  in  five  minutes, 


Doctor  and  Patient  33 

and  there  were  cigarettes  and  matches  on  his 
desk. 

Flaxman,  who  is  a  bachelor,  lived  In  a  small, 
detached,  commonplace  wooden  house,  with  a 
patch  of  lawn  bearing  in  the  midst  an  iron  funeral 
urn  painted  blue.  The  house  has  a  wing  with  a  side 
entrance  for  patients,  and  in  the  wing  were  the 
waiting-room  and  office,  with  a  bedroom  on  the 
floor  above. 

Making  my  way  along  the  unkempt  path  to  the 
side  door,  I  found  it  obstructed  by  an  old  pair  of 
rubber  boots,  a  snow-shovel,  and  a  down-at-heel 
broom.  Two  pulls  at  the  bell  failed  at  first  to  dis- 
turb the  peace  of  the  house,  but  finally  the  door  was 
cautiously  opened  by  a  coUarless  drab,  with  bare 
arms  and  a  water-soaked  blue  checked  apron,  who 
seemed  inclined  to  dispute  my  entrance.  The  sight 
of  Flaxman  on  the  front  walk  was  needed  to  con- 
vince her  that  I  told  the  truth.  I  sank  into  an 
office  chair,  as  she  shuffled  off  down  the  passage. 
A  strident  and  uncompromising  female  voice 
sounded  from  remote  upper  regions,  demanding  of 
"Maggie"  information  concerning  my  name,  sex, 
and  purposes,  and  animadverting  in  no  uncertain 
tones  on  the  character  of  any  person  who  would 


34  ^  Doctor's  Table  Talk 

call  at  such  an  hour  in  the  morning.  Later  I  was 
informed  that  the  cross  lady  abovestairs  was  Flax- 
man's  landlady,  and  the  mother  of  the  collarless 
drab. 

The  Interior  of  my  poor  friend's  establishment 
was  forlorn  enough,  though  I  knew  him  to  be  by 
nature  a  man  of  somewhat  exacting  requirements, 
interesting  tastes,  a  reader  of  good  books,  and  a 
lover  of  order.  The  struggle  of  life,  with  disap- 
pointment and  chagrin,  seemed  to  have  changed  all 
that.  Everything  about  his  office  suggested  neglect 
if  not  actual  poverty.  The  passage  was  uncarpeted 
and  unkempt;  the  office  door  stood  partly  open,  its 
wider  swing  obstructed  by  a  rickety  table,  on  which 
were  piled  high  dozens  of  unopened  medical  jour- 
nals, running  back  probably  for  two  or  three  years. 
The  heavy  odor  of  venerable  cigar  smoke  clogged 
the  atmosphere.  The  room  was  small  and  over- 
lumbered,  and  the  two  windows  were  inaccessible. 
Before  one  window  stood  the  office  desk,  littered 
and  uninteresting;  before  the  other  a  makeshift 
examining-table,  constructed  of  two  old  dry-goods 
boxes,  roughly  knocked  together,  and  partially 
covered  by  a  disorderly  rag  of  carpet.  On  the  desk 
stood  an  unpleasant-looking  glass  vase  full  of  some 


Doctor  and  Patient  35 

material  for  examination,  while  the  dump  of  patent 
medicine  venders  —  bottles,  boxes,  and  ointment 
jars  —  added  to  the  confusion.  And  yet,  somehow, 
you  knew  that  this  uncomely  lair  was  the  abode 
of  a  cultured  man  and  a  student.  The  walls,  every- 
where, were  lined  with  books  to  the  ceiling,  —  in 
tumbled  disarray,  to  be  sure,  —  but  books,  books, 
books;  German,  French,  and  English  books  and 
monographs  —  on  physiology,  chemistry,  bacteri- 
ology, and  practice;  mingled  with  volumes  of  Hume, 
Gibbon,  Ferrero,  Rhodes,  Keats,  Oscar  Wilde, 
Walter  Pater,  Ruskin,  Matthew  Arnold,  Izaak 
Walton,  and  even  Bernard  Shaw  and  Chesterton; 
the  "Atlantic  Monthly,"  the  "Outlook,"  "Spec- 
tator," and  "Harper's  Weekly"  sprawled  on  desk 
and  chair.  Some  loose  sheets  of  unfinished  manu- 
script showed  me  that  Flaxman  continued  his 
researches  on  the  function  and  diseases  of  the  thy- 
roid gland,  while  the  ready  microscope  and  micro- 
tome in  a  neighboring  closet  again  suggested  the 
serious  investigator. 

In  spite  of  the  hopeless  confusion  of  the  place,  I 
said  to  myself.  How  can  it  be  possible  that  the 
people  hereabout  do  not  see  that  this  is  a  true 
physician  come  among  them,  a  man  of  attain- 


36  A  Doctor^ s  Table  Talk 

ments  and  ability,  a  man  in  whom  there  is  no  guile  ? 
And  from  his  hospital  record  we  know  that  he  is 
abundantly  able  to  treat  disease;  or  is  it  that  the 
people  are  hopeless  philistines?  That  striking 
passage  of  Arthur  Benson's  came  into  my  mind, 
naming  Flaubert,  of  whom  he  writes:  "It  is  re- 
corded that  he  was  pained  at  contact  with  the 
bourgeois  mind,  not  because  such  people  thought 
and  felt  differently  from  himself,  but  because  they 
did  not  really  think  and  feel  at  all.  They  were 
interested  only  in  events.  Their  trivial  volubility, 
using  the  language  of  emotion  without  either  think- 
ing or  feeling,  was  what  horrified  him." 

Before  long  Flaxman  joined  me.  He  came  in 
with  a  deprecating  smile,  a  shake  of  the  head,  and 
a  what-do-you-think-of-it-all?  attitude  which  was 
hard  to  answer.  I  sat  back  in  the  patient's  chair, 
took  a  cigarette,  and  cogitated.  Slowly  light 
dawned  on  me,  though  I  knew  from  the  first  that 
the  case  was  far  from  hopeless. 

"The  great  trouble  with  you,  Flaxman,  is  that 
you  are  still  an  amateur.  You  have  not  got  to  work 
to  fend  off  starvation.  You  have  a  small  independ- 
ent income." 

"  Yes,  but  what  then  ? " 


Doctor  and  Patient  37 

"This,"  I  replied.  "As  you  know,  we  are  given 
to  dividing  mankind  into  classes  according  to  our 
notions,  —  into  those  who  do,  or  do  not,  answer 
letters;  into  those  who  do,  or  do  not,  close  the  door; 
into  those  who  are  always  on  time  and  those  who 
are  always  late;  and  so  on.  For  myself,  I  divide 
men  into  professionals  and  amateurs;  into  those 
who  must  work  seriously  in  order  to  live,  and  those 
who  work,  in  part  or  in  whole,  for  the  interest  or 
pleasure  they  get  out  of  it.  I  have  been  both  an 
amateur  and  a  professional,  and  I  know  the  distinc- 
tion as  many  men  do  not.  Until  I  was  twenty-eight 
years  old,  I  had  behind  me  the  potential  of  a  com- 
fortable income  —  all  I  needed.  I  worked  moder- 
ately, as  I  chose,  and  gained  some  sort  of  profes- 
sional position  —  not  much.  I  think  I  was  a  very 
decent  amateur,  but  I  had  not  grown  up.  Then, 
through  a  series  of  calamities,  I  found  myself 
bankrupt;  the  little  fortune  swept  away  beyond 
recall,  and  myself  involved  in  debts  and  obliga- 
tions for  which  I  was  not  to  blame.  Fortunately 
for  my  character  and  happiness  I  was  recently 
married. 

"Most  men  in  active  life  find  their  Rubicon, 
first  or  last.  That  loss  of  fortune  was  my  Rubicon. 


38  A  Doctor's  Table  Talk 

I  seemed  suddenly  to  have  advanced  from  child- 
hood to  maturity,  but  the  passage  of  the  river  was 
involuntary  and  rough.  For  months,  and  perhaps 
for  years,  the  new  life  seemed  to  belong  to  another 
person.  As  I  walked  the  familiar  streets  in  my 
anxious  and  morbid  state,  the  very  buildings  were 
strange,  and  the  old  friends  appeared  to  avoid 
me.  My  only  resources  —  indeed,  my  salvation  — 
were  incessant  work  and  the  satisfaction  of  home. 
Everything  else  went  widely  by  me.  But  I  trust, 
and  humbly  believe,  that  the  experience  made  a 
man  of  me.  So  I  became  a  professional.  Thanks 
to  the  confidence  of  a  few  generous  friends  I  was 
able  to  keep  my  feet  for  the  moment,  and  I  went 
on.  The  great  lesson  I  learned  was  not  self-reliance, 
—  thank  God,  most  American  men  are  born  with 
that,  —  but  a  knowledge  of  the  common  lot.  That 
is  what  levels  us  and  brings  us  into  sympathy  with 
our  kind.  Do  you  know  what  it  is  to  be  unable  to 
meet  your  rent  on  the  first  of  the  month,  or  to  get 
money  for  the  market  bill,  or  to  buy  shoes  for  your 
wife,  or  to  find  car  fare  for  yourself? 

"All  these  wants,  my  friend,  make  a  valuable 
experience,  which  you  have  never  been  privileged 
to  acquire.    But  take  courage;  your  little  bank 


Doctor  and  Patient  39 

account  will  not  hurt  you  much.  You  have  never 
had  to  say,  I  must  succeed,  to  live;  but  you  are 
man  enough  to  say,  I  will  succeed,  to  make  myself 
respected. 

"As  I  understand  it,  you  want  to  be  a  practi- 
tioner, not  a  mere  student.  Just  cast  your  eye  over 
this  outfit  of  yours.  How  can  you  expect  self- 
respecting  patients  to  come  to  you  in  such  sur- 
roundings.'' Your  tawdry  house;  your  dirty  side- 
walk; your  office  unkempt,  chaotic,  down-at-heel; 
your  carpet  torn;  your  desk  littered,  your  examin- 
ing-table  disreputable;  your  closed  windows  unap- 
proachable, —  and  your  whole  establishment  pre- 
sided over  by  a  strident  vixen  and  a  collarless  drab. 
Failure^  in  capital  letters,  is  written  large  on  every- 
thing you  own. 

"What  must  you  do?  Get  out  of  this  office. 
You  like  the  neighborhood;  stay  in  it.  Live  in  a 
decent,  properly  kept-up  house;  there  are  plenty 
such.  Find  a  landlady  who  will  make  your  inter- 
ests hers.  Live  in  one  room  if  you  must,  but  live  in 
peace  and  dignity.  If  you  can  afford  it,  get  an 
office  attendant  who  will  devote  herself  to  you  and 
to  nothing  else.  Give  your  patients  a  sense  of 
privacy,  comfort,  and  confidence  when  they  come 


40  A  Doctor's  Table  Talk 

to  you.  Let  them  feel  that  they  are  dealing  with  a 
successful  man,  who  understands  himself  and  them, 
and  will  help  them.  Such  trifles  go  far  towards 
making  a  family  doctor  popular. 

"Of  course  the  best  thing  of  all  for  you  would  be 
a  proper  marriage.  You  are  the  sort  of  man  who 
needs  a  domestic  keeper,  and  none  can  keep  you  so 
well  as  a  wife;  only  don't  marry  a  fool  or  a  spend- 
thrift. Whatever  you  do,  come  to  me  and  report 
when  six  months  have  passed." 


CHAPTER  III 

Doctor  and  Patient  —  // 

Early  in  June,  Ely  and  I  were  on  our  way  to  the 
New  Hampshire  hills  for  a  week's  fishing  with 
Primrose.  By  agreement  he  met  us  at  Concord, 
where  we  stopped  off  a  couple  of  days  for  the  an- 
nual "Anniversary"  and  boat-race  of  St.  Paul's 
School.  All  three  of  us  are  old  St.  Paul's  boys,  and 
were  following  a  frequent  plan.  It  was  my  more 
than  thirtieth  "Anniversary,"  for  I  entered  the 
school  as  a  small  Fourth  Former  in  1878,  and  the 
place  is  dear  to  me.  No  old  school-boy  forgets  his 
introduction  to  that  new,  mysterious,  and  some- 
what terrifying  school  life.  As  we  drive  out  from 
the  Concord  station,  two  miles  to  the  School, 
every  house,  tree,  and  wall  is  familiar.  There,  on 
the  right,  is  the  Phoenix,  and  there  the  Eagle 
Hotel;  why  so  named  no  man  knoweth,  but 
famous  in  fact  and  fiction  as  the  headquarters  of 
questionable  party  politics.  On  the  left  of  the 
broad  Main  Street,  lined  with  farm  wagons,  and 
punctuated  with  "Democrat"  buggies  stopping  for 


42  A  Doctor's  Table  Talk 

neighborly  salutes,  and  obstructing  traffic,  —  on 
the  left  stands  the  old  State  House,  dignified  and 
remote  in  its  grove  of  elms.  Now  our  "hack,"  with 
its  high-boned  horses,  swings  off  to  the  left,  mounts 
the  hill,  and  bears  us  past  the  "corner  store"  and 
out  into  the  country.  The  broad-stretching  valley 
of  the  Merrimac,  its  fields  of  waving  green,  its 
prosperous-looking  farms,  and  in  the  middle  dis- 
tance its  state  fair-grounds,  stretches  far  on  our 
front.  One  smells  the  old  familiar  smells  of  the 
region,  and  begins  to  "sense"  the  School,  still  a 
long  mile  beyond. 

The  day  was  ideal  for  a  boat-race,  and  as 
we  approached  the  School  we  encountered  joyous 
groups  of  boys,  sauntering  on  the  road,  and  burn- 
ing time.  "Pleasant  View,"  Mecca  of  Christian 
Science,  with  its  pink  walls  and  gingerbread  con- 
struction, lies  to  the  left;  to  the  right  is  the  bat- 
tered and  picturesque  old  Indian  monument,  com- 
memorating early  settlers  murdered  by  redskins. 
Farther  down  the  road  is  the  cheerful  Alumni 
House,  —  the  School  inn,  —  and  beyond,  in  the 
dip  of  the  valley,  and  bordering  road  and  pond«, 
the  scattered  school  buildings  themselves,  with  the 
beautiful  chapel  tower  arising  gently  above  the 


Doctor  and  Patient  43 

trees,  and  presiding  over  all.  The  famous  playing- 
fields  of  Eton  are  no  more  precious  to  old  Etonians 
than  are  these  friendly  walls  and  gracious  elms 
and  meadows  to  those  of  us  who  love  St.  Paul's. 

We  drove  to  the  rooms  of  my  old  friend  Scholas- 
ticus  to  deposit  our  modest  luggage,  and  then 
scattered  to  various  houses  for  the  midday  School 
dinner,  to  meet  later  for  the  race  at  Long  Pond, 
two  miles  distant  across  the  hills. 

At  the  Pond,  that  afternoon,  I  found  Scholas- 
ticus,  after  some  search,  and,  seated  together  on 
the  hillside,  we  enjoyed  the  races.  It  is  a  beautiful 
sight  on  a  clear  summer's  day.  Long  Pond  lies  in 
an  oval  basin  about  two  miles  long  and  half  a  mile 
wide.  Farms  and  pine  woods  surround  it,  while  the 
slopes  rise  sharply  from  its  sparkling  waters.  To- 
wards the  head  of  the  Pond,  which  we  overlook, 
clusters  of  boys  with  their  elders  throng  the  shores. 
The  whole  School  divides  itself  into  two  clubs, 
—  Shattuck  and  Halcyon,  —  rivals  now  for  many 
school-boy  generations.  Fathers,  sons,  and  even 
grandsons  cheer  their  club  colors.  Single  shells  and 
eight-oared  crews  frisk  upon  the  lake.  Some  ninety 
boys  in  all  are  in  the  boats,  —  "First"  crews, 
"Second"  crews,  "Third'*   crews,  down  to  single 


44  ^  Doctor's  Table  Talk 

scullers,  —  they  float  before  us.  I  recall  to  Scho- 
lasticus  the  day  when  he  was  a  young  master,  and 
I  a  Sixth  Form  boy  in  one  of  the  boats ;  how  with 
no  thought  but  of  an  easy  victory  my  crew  paddled 
out  to  the  start;  and  how  from  the  word  "Go"  until 
our  gasping  finish,  we  were  steadily  and  continu- 
ously led  by  our  despised  and  pitying  rivals.  Poor, 
forlorn  company  of  lads,  with  broken  hearts,  as  we 
thought,  —  I  see  us  now  paddling  across  the  line, 
and  rallying  to  a  feeble  and  raucous  cheer  for  the 
exulting  enemy. 

To-day,  however,  the  tables  are  turned,  and  all 
goes  as  we  would  have  it,  even  to  the  last.  A 
"blue"  sculler  wins,  then  a  "blue"  Fifth  crew,  a 
Fourth,  a  Third,  a  Second,  a  First.  It  is  a  blue  day, 
indeed,  —  never  to  be  forgotten,  —  but  not  flip- 
pantly to  be  rehearsed.  The  catastrophe  for  the 
red  is  too  awful  and  overwhelming,  and  the  next 
year  may  plunge  us  all  in  grief.  The  cheers  become 
few  and  broken;  unfeeling  parents  only,  who  see 
their  boys  struggling  in  the  boats  of  blue,  whole- 
heartedly rejoice  until  the  end. 

A  friendly  motor  returns  us  to  the  School;  we 
watch  the  flag-raising  and  hear  the  generous  cheers; 
we  sup,  and  as  evening  falls  we  three  old  friends 


Doctor  and  Patient  45 

gather  ourselves  again  with  Scholasticus  to  gossip 
of  the  School,  the  world,  and  the  year  that's  nearly 
gone. 

Scholasticus  is  a  charming  person;  of  middle 
height,  erect,  alert,  he  carries  his  handsome  white 
head  well  back  on  broad  shoulders,  while  his  clean- 
shaven face  and  winning  smile  attract  attention 
and  response.  Though  living  in  a  somewhat  eccle- 
siastical atmosphere,  he  has  never  thought  of  tak- 
ing orders,  and  he  wears  his  rough  gray  suit  and 
dark  blue  tie  with  a  certain  air  of  distinction 
among  the  black  coats  of  some  of  his  colleagues. 

He  is  no  hermit,  no  pessimist.  He  loves  men  and 
affairs,  and  to  talk  and  read  of  them.  While  Latin 
is  his  specialty,  his  fine  mind  is  a  storehouse  of 
varied  information.  His  zeal  for  facts  and  his  curi- 
osity about  all  things  under  the  sun  are  never  sated. 
Perhaps  his  greatest  attraction  for  others  is  the 
pleasure  he  seems  to  receive  from  the  prattle  of  his 
friends,  on  whom  he  draws  patiently;  whose  pride 
in  their  powers  of  speech  expands  under  his  smile 
and  kindly  words. 

Encouraged  by  Scholasticus,  Primrose  usurped 
the  floor.  "Of  course  Scholasticus  is  interested  in 
our  problems,"  he  vociferated;  "he  knows  the 


46  A  Doctor's  Table  Talk 

feebleness  of  our  minds,  —  none  better;  and  he 
knows  as  well  as  we  do  what  a  mess  the  whole  edu- 
cational world  is  in  to-day.  And  by  *  educational 
world '  I  don't  mean  the  world  of  school  and  college 
merely;  I  group  under  the  word  *  education'  all 
that  concerns  intellectual  progress:  the  education 
of  professional  men  and  the  making  them  efficient ; 
the  education  of  the  politicians,  of  the  labor  unions, 
of  the  farmers,  of  the  financial,  manufacturing, 
and  commercial  classes,  —  of  all  those  people 
whose  properly  coordinated  efforts  and  coopera- 
tion should  go  to  make  the  world  so  much  easier 
and  pleasanter  a  place  in  which  to  live.  One  sees 
clearly  what  ought  to  be  done,  and  at  the  same  time 
one  is  impotent  to  accomplish  results." 

"Yet  improvement  is  going  on,  if  only  you  had 
the  grace  to  admit  it,"  said  Ely;  "the  world 
is  better  than  it  was  when  we  were  boys,  and 
vastly  better  than  it  was  two  hundred  years  ago. 
But  what  a  banal  remark!  Of  course  to  us,  as 
physicians,  nothing  is  more  obvious  than  the  in- 
crease in  the  world's  population,  —  owing  to  the 
infrequency  of  war,  —  the  prolonging  of  human 
life,  the  elimination  of  much  epidemic  disease, 
and  the  great  diminution  of  infant  mortality.    In 


Doctor  and  Patient  47 

view  of  such  facts,  the  common  talk  of  race-suicide 
sounds  rubbishy.  I  suppose,  though,  you  are 
coming  around  to  the  problems  of  the  medical 
profession.  They  are  what  Scholasticus  wants  to 
hear  about." 

"Nay,  nay,"  remarks  our  friend  the  scholar; 
"but  indeed  you  are  already  on  the  subject.  What 
chiefly  puzzles  me  in  these  days  of  specializing  is 
how  to  find  a  doctor  in  the  city  to  take  care  of  me 
when  I  am  ill.  Primrose  suggested  that  problem 
when  he  spoke  of  progressive  men  and  groups  of 
men  failing  to  cooperate  for  the  greatest  efficiency. 
Men  of  varied  affairs  don't  cooperate  because  they 
know  too  little  of  each  other,  and  of  how  to  coop- 
erate for  the  greatest  benefit  to  the  public.  Broad- 
minded  men  of  wide  general  information  are  hard 
to  find;  yet  such  are  the  men  who  must  be  found, 
or  possibly  trained,  to  coordinate  the  various  cogs 
in  our  modern .  social  structure.  We  are  making 
progress,  but  very  slowly,  considering  the  intelli- 
gence we  boast.  The  great  machine  still  runs 
rumbling  and  rusty  in  spite  of  the  more  or  less 
groping  efforts  of  chambers  of  commerce,  worlds' 
fairs  and  houses  of  governors.  Each  man  and 
group  of  men  —  labor  unions,  employers  of  labor. 


48  A  Doctor's  Table  Talk 

political  parties,  farmers  and  merchants,  lawyers, 
doctors,  and  artisans  —  is  looking  out  for  his  or  its 
own  interest,  and  playing  his  own  hand  alone, 
regardless  of  all  the  rest.  These  men  can't  define 
the  word  'cooperation.'  They  are  far,  indeed,  from 
it,  as  their  inane  lawsuits,  tariff  bills,  and  labor 
wars  show  us  every  day.  Since  we  can't  have  an 
all-wise  God,  or  dictator,  or  czar  to  straighten  out 
the  tangle,  we  must  go  ahead  in  our  old  stupid, 
blundering,  evolutionary  fashion.  But  that  does 
not  half  answer  my  first  question:  when  I  am  in 
the  city,  how  am  I  to  find  an  out-and-out,  old- 
fashioned  doctor  for  my  needs  .f*  Your  specialists 
don't  help,  and  there  is  no  one  but  a  hotel  clerk 
to  tell  me  what  to  do." 

Scholasticus  had  hit  upon  one  of  our  most  press- 
ing and  difficult  problems.  When  my  friends  and 
I  were  medical  students,  one  of  our  far-sighted 
teachers  advised  us  all  to  become  general  practi- 
tioners. They  are  needed  more  and  more,  he  said; 
and  the  men  who  stick  to  general  practice  will  do 
the  most  good,  and  make  the  best  incomes. 

"The  other  day,"  I  remarked, "  a  well-known  in- 
ternist told  me  that  there  are  but  two  first-class 
family  doctors  left  in  the  city.   Only  yesterday  I 


Doctor  and  Patient  49 

met  with  another  example  of  the  situation  about 
which  Scholasticus  complains:  A  young  woman, 
reader  and  companion  to  an  elderly  invalid,  broke 
down  through  anxiety  and  loss  of  sleep,  and  be- 
came the  victim  of  what  is  still  called  'neurasthe- 
nia.' She  was  advised  to  put  herself  under  the  care 
of  a  certain  Dr.  Blackwell.  After  seeing  her  several 
times  Dr.  Blackwell  concluded  that  she  was  *  no- 
thing but  a  nervous  wreck,'  and  sent  her  to  a  sana- 
torium, with  the  advice  that  she  be  given  a  long 
rest.  The  sanatorium  physicians  thought  differ- 
ently, and  put  her  through  a  course  of  *  feeding  up' 
and  active  exercises.  By  the  end  of  two  weeks  she 
was  completely  undone,  and  her  friends,  in  great 
distress,  came  to  me  asking  what  course  to  follow. 
They  said  she  was  in  despair  about  the  sanatorium, 
and  knew  not  what  to  do.  I  pointed  out  to  them 
that  Dr.  Blackwell  had  been  acting  as  her  family 
physician,  and  that  they  had  best  consult  him  as  to 
her  proper  course.  Further,  I  reminded  them  that  I 
knew  nothing  at  first-hand  about  her  case.  Accord- 
ingly they  went  to  Dr.  Blackwell,  who  informed 
them  that  he  was  a  specialist  in  digestive  disorders, 
that  he  had  sent  the  patient  to  a  sanatorium  for  the 
treatment  of  her  nervous  troubles,  that  he  had  no 


50  A  Doctor's  Table  Talk 

further  advice  to  give,  and  that  he  must  now  wash 
his  hands  of  the  whole  affair.  The  much  buffeted 
people,  in  sore  distress,  then  came  back  to  me;  and 
realizing  at  last  that  Dr.  Blackwell  is  a  donkey,  I 
sent  them  to  a  safe  general  practitioner  who  has 
saved  the  day  for  his  happy  patient. 

"Such  stories  are  common  enough,  but  they 
don't  argue,  as  many  shallow  persons  think  and 
say,  that  doctors  are  'no  good,'  and  that  the  pro- 
fession of  medicine  is  a  failure.  Entirely  aside  from 
any  question  of  scientific  progress,  the  dividing 
of  physicians  into  specialists  is  the  most  momen- 
tous feature  of  modern  practice.  Neither  the  pro- 
fession nor  the  public  has  yet  adapted  itself  to 
the  change,  or  learned  how  best  to  utilize  the  new 
forces.  In  other  words,  the  many  cogs  in  the 
machine  are  not  yet  coordinated;  and  the  family 
doctor  must  survive,  if  only  to  attend  to  that 
coordinating. 

"The  question  of  providing  competent  and 
humane  physicians  to  take  care  of  the  sick  is  be- 
coming increasingly  more  urgent,  as  Scholasticus 
intimates ;  and  the  trouble  lies  with  the  high-grade 
medical  schools  and  hospitals.  These  institutions 
are  becoming  dominated  by  men  largely  unfamiliar 


Doctor  and  Patient  51 

with  the  problems  of  practice;  their  leading  idea 
being  to  train  both  students  and  physicians  to  an 
expert  knowledge  of  preventive  medicine,  and  the 
theory  rather  than  the  practice  of  physic.  Teach- 
ers of  undergraduate  students  realize  their  own 
shortcomings  more  or  less,  but  justify  their  course 
by  saying  that  the  young  men  will  get  all  the  bed- 
side practice  they  want  when  they  become  hospital 
internes.  In  a  measure  that  is  true,  and  the  young 
men,  in  the  course  of  one  or  two  years,  do  become 
familiar  with  disease  as  seen  in  hospitals ;  but  how 
are  they  to  acquire  a  knowledge  of  disease  as  seen 
in  private  practice.^  The  rank  and  file  are  content 
to  work  out  their  own  salvation  through  the  stress 
of  daily  experience,  and  the  theoretical  knowl- 
edge already  theirs.  Laboratories  and  hospitals  no 
longer  concern  them.  The  more  ambitious  men, 
however,  —  those  who  think  they  may  become 
qualified  to  lead  In  medical  progress,  —  find  per- 
manent hospital  positions,  and  struggle  to  keep 
to  the  front  In  hospital,  teaching,  and  laboratory 
work  as  well  as  in  practice.  They  fail,  of  course. 
You  can't  be  a  great  laboratory  Investigator  and  a 
good  practitioner  at  the  same  time. 

"Then  there  is  that  pernicious  advice,  which  is 


52  A  Doctor'' s  Table  Talk 

constantly  given  to  beginners : '  If  you  have  a  little 
money  of  your  own,  stay  in  the  city  and  wait  for 
practice.  If  you  must  support  yourself  at  once, 
go  to  a  small  town  or  to  the  country';  —  the  re- 
sult of  which  advice,  when  it  is  taken,  is  to  send 
away  our  most  promising  men.  Per  contra,  the 
more  or  less  idle  amateur,  waiting  for  practice, 
is  a  sight  for  gods  and  men.  You  will  find  him 
loafing  at  his  club  any  afternoon  after  four  o'clock. 
From  the  best  of  these  men  who  elect  to  wait,  the 
hospital  staffs  are  recruited.  Happily,  every  year 
one  or  two  genuine  professionals  remain  in  the  city 
struggle.  They  are  our  chosen  ones. 

"Picture  to  yourself  then,  the  young  internist, 
five  or  ten  years  established,  immersed  in  hospital 
and  academic  work:  his  best  energies  so  occupied; 
supported,  perhaps,  by  his  modest  patrimony,  or 
having  taken  to  himself  a  wife  with  money.  From 
such  material,  general  practitioners  —  able,  expe- 
rienced, resourceful  —  are  not  made.  These  hos- 
pital men  do  not  stand  ready,  day  and  night,  for 
small  fees  or  for  no  fees,  to  rush  to  the  aid  of  the 
afflicted.  Soon  they  learn  to  call  themselves  'con- 
sultants,' and  to  keep  hours  and  appointments  so 
irregularly  that  practice  cannot  find  them.   Then 

I 


Doctor  and  Patient  53 

patients  float  off  —  to  the  virtuous  and  patient 
rank  and  file,  to  irregular  practitioners,  to  osteo- 
pathists,  to  Christian  Scientists,  and  the  like. 
When  the  chief  shepherds  have,  for  a  generation, 
so  neglected  and  maltreated  their  flocks,  what  can 
you  expect?  Many  of  these  self-satisfied  seekers 
after  causes  have  become  so  contemptuous  and  so 
inexpert  in  the  treatment  of  disease  that  the  words 
*  social  service '  are  to  them  a  stench,  and  the  suc- 
cesses of  psychotherapy  a  cause  for  bitterness  and 
intolerant  outcries,  —  Vinfame  of  Voltaire,  which 
even  among  *  scientists'  will  never  die." 

"What  then?  where  is  your  remedy?"  says 
Scholasticus  with  a  weary  smile,  when  I  reach  the 
end  of  my  holding  forth. 

Ely  took  up  the  tale.  "  There  are  two  courses  to 
follow,  —  we  may  choose  one  or  both :  let  the  hos- 
pital trustees  see  to  it  that  more  men  of  their 
staffs  are  encouraged  to  practice  general  medicine, 
and  not  to  give  the  best  part  of  their  days  to  the 
hospital ;  or,  let  little  groups  of  specialists,  includ- 
ing general  practitioners,  form  associations  for 
practice.  To  such  a  group,  as  to  an  ordinary  doc- 
tor, or  to  a  small  hospital,  a  patient  should  be  able 
to  go,  or  to  send,  at  any  time,  and  get  there  any 


54  A  Doctor's  Table  Talk 

sort  of  service  he  wants,  and  at  a  sliding-scale-fee, 
as  is  the  fact  now  with  individual  practitioners. 
There  are  many  other  reasons  for  forming  such 
groups  in  practice,  —  chief  among  which  is  this, 
that  thus  we  may  best  reach  the  great  mass  of  the 
public,  the  people  of  moderate  means;  those  who 
cannot  now  afford  freely  to  consult  specialists,  but 
who  do  not  wish  to  be  classed  with  the  very  poor, 
by  attending  the  free  clinics  of  the  municipal  hos- 
pitals. That  great  middle  class,  estimated  at  eighty 
per  cent  of  our  people,  fail  now  to  get  the  full  bene- 
fit of  modern  scientific  medicine." 

"Of  course,"  Primrose  remarked,  "you  city  men 
have  problems  to  meet  which  don't  especially  con- 
cern us  country  doctors.  I  have  to  take  care  of 
every  variety  of  disease  from  felons  and  broken 
arms  to  consumption  and  brain  abscess.  When  I 
have  a  case  I  can't  handle,  I  send  for  one  of  you 
good-natured  men  to  help  me  out,  or  I  persuade 
my  patient  to  go  to  the  city. 

"There  are  certain  features  of  practice,  however, 
which  we  must  all  consider,  —  in  dealing  with 
which  we  meet  on  common  ground;  I  mean  our 
personal  contact  with  patients,  —  what  one  might 
call  the  human,  or  inhuman,  side  of  practice.   In 


Doctor  and  Patient  55 

that  relation  the  real  physician  or  the  humbug  is 
displayed,  —  I  don't  care  what  his  training  or  what 
his  ability  for  writing  scientific  papers.  It's  the 
old  argumentum  ad  hominem.  Where  the  personal 
relation  is  concerned,  you  can't  make  a  silk  purse 
out  of  a  sow's  ear.  You  may  think  you  can  make 
a  fair  substitute  for  a  physician  out  of  a  machine 
with  a  test-tube  in  his  hand.  That's  the  reason 
why  so  many  of  you  people  imagine  you  prefer 
impersonal  consulting  work  to  the  hard  soul- 
exhausting  grind  of  a  true  physician.  But  you  can't 
eliminate  the  personal  element.  The  community 
find  you  out,  and  hate  you,  or  laugh  at  you,  or 
love  you,  just  as  you  may  deserve." 

Scholasticus  smiled  a  sympathetic  smile. 

"My  friends,  my  friends,"  I  said,  "such  talk  is 
near  treason.  Is  it  for  me,  unworthy,  to  defend 
'scientific  medicine'.?  The  other  day  I  said  some- 
thing of  Primrose's  heresy  to  our  friend  Bluff,  the 
pathologist.  It  was  a  plea  for  the  old-time  human- 
ist doctor  as  compared  with  the  modern  product. 

"'Nonsense,  nonsense!'  he  snorted;  'those  old 
ladies  may  have  been  good-natured,  but  they  did 
awful  harm,  awful  harm,  awful  harm!'  Can't  you 
hear  him? 


56  A  Doctor* s  Table  Talk 

"What's  the  use,  however,  of  continually  re- 
hearsing the  triumphs  of  medicine  in  the  past  hun- 
dred years?  They  are  certainly  interesting,  but 
not  marvelous.  The  teachings  of  such  as  Voltaire, 
and  then  the  French  Revolution,  set  men  free  to 
think,  without  fear  of  what  king  or  church  might 
say  or  do.  Of  course,  as  soon  as  men  began  to  think 
again,  and  to  express  themselves,  after  the  lapse  of 
fifteen  hundred  years,  then  they  began  to  discover 
things.  But  this  was  no  more  true  of  medicine  than 
of  other  activities.  The  re-discovery  of  the  capacity 
for  thought  is  the  great  triumph  of  modern  times. 
In  medicine,  of  course,  there  are  many  things  to 
record  of  the  past  century  —  from  Jenner's  vacci- 
nation, let  us  say,  through  the  development  of 
pathology,  physiology,  chemistry,  and  the  rest  of 
it,  down  to  the  most  recent  discoveries  in  immunity, 
in  serum  therapy,  and  the  superb  jugglery  of  mod- 
ern surgery.  But  these  are  heavy  subjects  for  mid- 
night gossip. 

"We  were  talking  not  long  ago  about  the 
troubles  of  us  commonplace  doctors,  and  of  how 
men  are  saying  that  practice  is  leaving  the  regular 
profession.  Surely  the  fault  is  mainly  ours.  As  I 
said,  —  when  young  doctors  come  to  me  for  advice, 


Doctor  and  Patient  57 

I  talk  to  them,  among  other  things,  of  their  per- 
sonal relations  with  their  patients  and  their 
patients'  friends.  We  can't  all  be  as  brutal  as  my 
old  acquaintance  Roland.  When  an  anxious,  in- 
quiring busy-body  came  to  his  office  to  ask,  *How 
is  dear  Mary?  and  what  did  you  find  her  trouble  to 
be .'"  —  he  used  to  send  the  busy-body  a  bill  for  ten 
dollars.  The  remedy  was  effective." 

"Roland  was  n't  a  real  doctor,"  said  Ely.  "He 
was  a  business  maH,  which,  thank  God,  few  doc- 
tors are.  If  we  were,  practice  would  be  leaving  us 
faster  than  it  is  said  to  leave  us  now. 

"There's  an  inevitable  fineness  about  a  physi- 
cian's life,  —  and  his  wide  grasp  of  human  experi- 
ence as  compared  with  that  of  other  men,  —  which 
even  the  meanest  of  us  in  some  fashion  perceives.  It 
usually  subdues  the  more  vulgar  business  instinct.'* 

Such  were  the  reflections  of  Ely,  and  I  believe 
them  to  be  sound;  but  there  are  certain  worldly- 
wise  aids  to  practice  which  the  beginner  should 
consider.  For  example,  he  should. make  his  rounds 
promptly,  and  should  make  his  new  calls  first  and 
at  once.  There  is  a  common  sort  of  medical  goose 
who  seems  to  think  that  calls  made  tardily,  or  put 
off  for  a  day,  impress  patients  with  the  doctor's 


58  A  Doctor's  Table  Talk 

importance  and  rush  of  business.  Alas;  late  calls 
do  no  such  thing.  They  usually  create  the  impres- 
sion that  the  fellow  is  inefficient  and  lazy.  My  old 
friend  Dr.  Circumstance  is  an  exception  to  the 
rule;  and  being  popular  and  amazingly  effective, 
his  example  has  done  much  harm  to  admiring 
juniors.  He  is  an  abnormally  busy  surgeon  and  is 
generally  from  an  hour  to  two  hours  late  for  ap- 
pointments. He  bites  off  too  much.  But  then  he 
makes  up  for  it.  He  comes  in,  breathless  and 
troubled,  to  the  patient  and  his  friends ;  and  ingen- 
uously takes  them  into  his  confidence.  They  are 
made  partners  in  his  trials.  He  explains  that  he 
has  driven  furiously  from  a  terrible  operation, 
where  he  overcame  difficulties  never  before  re- 
corded; and  that,  at  last,  he  removed  an  appendix, 
which  in  another  thirteen  minutes  would  have 
killed  the  luckless  patient.  However,  modern 
surgical  science  prevailed.  We  name  no  names, 
but  you  are  given  to  understand  that  the  patient 
came  on  last  night  from  Washington  in  desperate 
haste  and  by  special  train.  —  How  is  the  stock 
market  acting  now.  Job? 

Let  not  youthful  genius  be  misled.    Fine  old 
Circumstance  can  carry  it  off,  but  you  can't. 


Doctor  and  Patient  59 

Again,  and  above  all  things,  don't  arrive  late 
for  a  consultation.  You  are  allowed  five  minutes' 
grace,  but  err  on  the  wrong  side.  You  can't  hum- 
bug your  colleagues. 

In  the  sick-room  always  try  to  be  self-controlled, 
kind,  firm,  and  sustaining;  and  never  tell  needless 
fibs  to  a  very  ill  patient.  To  some  one  responsible 
member  of  his  family,  at  least,  always  tell  the 
exact  truth.  In  talking  to  your  patient,  don't  be 
guided  by  his  wife  or  daughter,  or  some  other,  as 
to  what  you  may  tell  him.  Under  the  stress  of 
severe  illness  in  the  house,  the  advice  of  wife  and 
daughter  is  often  silly.  They  cannot  get  the  pa- 
tient's point  of  view.  If  you  are  sick  unto  death, 
you  regard  death  with  a  composure  of  which  well 
people  have  small  conception.  But  don't  worry 
over-much.  The  man  or  woman  in  acute  illness 
who  asks  the  blunt  question,  —  Am  I  going  to  die? 
—  is  very  rare  indeed. 

On  the  other  hand,  the  chronic  invalid  —  the 
woman  with  cancer,  or  Bright's  disease  —  often 
wants  to  know  the  truth,  and  she  has  a  right  to 
know.  Tell  her  the  truth,  and  as  cheerfully  as 
possible,  for  you  need  not  carry  gloom.  Here  is  a 
chance  for  some  helpful  psychotherapy.    Admit 


6o  A  Doctor's  Table  Talk 

that  the  patient's  ailment  is  desperate  or  incurable, 
but  point  out  that  she  still  has  many  months  or 
years  of  life.  The  difference  between  her  and  her 
attendant  sister  is  that  she  knows  in  advance  the 
disease  which  is  to  cause  her  death,  while  her  sister 
is  still  ignorant  of  the  nature  of  her  own  fatal  ill- 
ness: "You  will  surprise  them  all  yet;  you  will  out- 
live half  your  family.  None  of  us  is  immortal,  and 
the  going  is  not  hard.  We've  all  got  to  go  before 
long.  The  only  question  is,  —  who  will  go  first?" 

With  such  talk  and  encouragement,  fortified  by 
his  other  palliative  treatment,  the  physician  will 
find  that  most  intelligent  patients  regain  their 
composure  and  leave  his  office  in  a  reasonably 
cheerful  and  philosophical  state  of  mind. 

The  physician  at  a  patient's  house,  on  the  one 
hand,  or  in  his  own  office  on  the  other,  occupies 
somewhat  different  roles;  not  that  in  the  one  case 
he  is  guest  and  in  the  other  case  host,  though  in 
some  slight  measure  that  is  the  fact,  but  because 
the  doctor  has  far  better  control  of  his  patient  and 
of  his  own  time  at  her  house  than  in  his  office. 
Observe  the  "her."  The  majority  of  calls  are  from 
women.  When  at  her  house,  you  ask  your  questions, 
make  your  examination,  give  your  directions,  and 


Doctor  and  Patient  6 1 

go.  Prompt,  kindly  expedition  gives  a  sense  of 
your  efficiency  and  dignity.  Rarely  is  it  necessary 
to  stop  for  gossip. 

In  your  office,  on  the  other  hand,  you  may  be 
at  the  mercy  of  a  heedless  or  selfish  patient.  A  very 
busy  consultant,  with  a  trained  office  attendant, 
can  have  patients  shown  in  and  out  rapidly  at  the 
touch  of  a  bell;  but  the  average  practitioner,  with 
his  small  and  irregular  office  practice,  must  suffer 
the  whims  of  the  heathen.  Don't  hurt  their  feelings, 
unless  they  be  mere  humbugs  and  bores.  Bear  with 
them  as  long  as  you  think  proper,  then  rise  and  get 
rid  of  them  by  the  plain  statement  that  you  are 
busy,  or  that  patients  by  appointment  are  awaiting 
you  —  as  the  case  may  be,  and  that  you  will  see 
them  again  that  day  week.  Some  day  I  must  write 
a  book  on  the  miseries  of  a  doctor's  consulting- 
room,  from  the  doctor's  point  of  view. 

In  these  days  of  trained  nurses  and  social  service 
workers  it  is  comparatively  easy  to  get  your  direc- 
tions for  treatment  carried  out  in  the  case  of  bed 
patients  and  of  serious  illness;  but  in  the  case  of 
office  patients  you  are  never  sure.  Don't  be  mys- 
terious, except,  perhaps,  with  some  children.  Don't 
tell  your  patient  to  rise  at  7.13,  to  go  to  bed  at 


62  A  Doctor's  Table  Talk 

9.48,  and  to  take  an  unknown  pill  on  the  stroke  of 
each  half-hour  —  unless,  indeed,  such  directions 
are  useful  to  jog  his  memory.  If  you  are  trying  to 
impress  him  by  humbug,  he  will  find  you  out  and 
dislike  you.  But  take  him  into  your  confidence, 
explain  to  him  the  nature  of  his  own  case,  and 
what  you  intend  to  do  for  him,  and  so  secure  his 
interest  and  effective  cooperation,  —  except  he 
be  a  fool,  in  which  case  you  must  use  the  axe. 
Write  out  full  and  explicit  directions  for  every  pa- 
tient, whether  he  has  a  nurse  or  not.  Thus  will 
you  be  sure  of  obedience.  The  spoken  word  is  as 
snow  in  the  desert. 

Another  detail  of  practice  which  modern  methods 
have  made  important  is  the  pathologist's  examina- 
tion and  report  on  bits  of  tissue,  and  the  like,  re- 
moved from  diseased  organs,  as  well  as  the  results 
of  X-ray  and  other  special  and  difficult  examina- 
tions. Intelligent  and  inquisitive  patients  await 
these  reports  with  the  greatest  interest,  and  often 
with  anxiety.  Don't  disappoint  them.  Don't  tell 
them  you  will  send  the  report  on  Monday,  when 
you  know  you  cannot  send  it  until  Saturday. 
There's  a  deal  of  cruelty  in  the  world.  We  must 
not  add  to  it.  Send  the  report  at  the  earliest  possi- 


Doctor  and  Patient  63 

ble  moment,  but  make  no  foolish  promises.  Explain 
to  your  patient  that  the  special  expert  examiners  are 
not  your  assistants  (as  some  jobbing  practitioners 
represent  them),  but  are  proper  and  dignified  con- 
sultants. Then  the  patient  will  not  be  surprised  when 
he  receives  a  consultant's  bill  for  special  services. 
In  regard  to  that  matter  of  bills  and  fees,  a  deal 
of  misinformation  and  twaddle  is  published  in  the 
daily  papers,  and  there  Is  a  quite  constant  pressure 
to  make  it  appear  that  doctors  are  extortioners. 
Not  long  ago  an  influential  Boston  newspaper 
published  an  editorial  which  suggested  that  physi- 
cians are  in  the  habit  of  charging  fees  according  to 
the  location  of  their  offices:  "Do  not  some  physi- 
cians even  now  charge  according  to  the  locality  in 
which  they  live,  without  reference  to  the  nature 
of  the  case,  and  the  amount  of  time  and  skill  ex- 
pended.^ There  are  few  doctors  who  would  admit 
the  reasonableness  of  a  sliding  scale.  The  majority 
charge  the  servant  girl  and  her  mistress  alike. 
There  are  glorious  exceptions,  men  of  marked 
ability  who  take  the  trouble  to  inquire  into  the 
pecuniary  condition  of  a  patient,  and  then  charge 
accordingly,  after  asking  only  a  nominal  sum, 
that  the  patient's  pride  may  not  be  wounded.'* 


64  A  Doctor's  Table  Talk 

As  one  of  our  distinguished  fellow  citizens  would 
say,  the  main  contention  in  that  editorial  charge  is 
an  unqualified  and  unmitigated  falsehood.  With 
the  rarest  exceptions  physicians  make  their  fees 
without  regard  to  locality,  and  they  all  employ 
the  sliding  scale.  What  humane  physician  would 
carry  his  patient  through  a  severe  illness,  only  to 
cast  him  down  Into  the  depths  of  wretchedness  at 
the  end,  by  insisting  upon  charges  which  the 
patient  could  not  pay?  Common  sense  and  the 
claims  of  his  own  bank  account  impel  the  doctor 
to  a  sliding  scale.  If  his  charges  were  fixed  and 
immutable,  they  would  inevitably  be  low  to  accom- 
modate his  poorest  patients.  I  find  that  physicians 
and  most  surgeons  have  what  they  call  their  stan- 
dard fee,  which  they  raise  or  lower,  according  to  the 
circumstances  of  the  patient  and  the  demands  of 
the  case.  In  spite  of  sneers,  "  Charge  all  that  the 
traffic  will  bear"  cannot  be  applied  to  doctors. 

There  is  another  side,  a  familiar  side,  to  this 
question  of  fees.  Some  months  ago  a  cheerful  and 
breezy  woman,  dressed  in  handsome  furs,  brought 
to  see  me  her  little  girl,  also  well  dressed.  The 
wardrobes  of  the  two  represented  a  thousand  dol- 
lars, at  least.  The  child  stood  in  need  of  a  serious 


Doctor  and  Patient  65 

operation,  for  which,  in  the  case  of  wealthy  parents, 
the  figures  four  hundred,  or  five  hundred,  dollars 
would  be  reasonable,  considering  the  responsibility- 
assumed  by  the  surgeon  and  the  immense  comfort 
and  relief  to  be  secured  by  the  child.  From  the 
first,  however,  the  mother  was  insistently  voluble 
on  the  subject  of  the  fee,  and  vowed  that  her  hus- 
band could  pay  but  fifty  dollars.  I  agreed  and 
operated.  During  the  operation  the  family  physi- 
cian said  to  me,  "What  is  Mr.  Jacobs  to  pay  you?" 
I  told  him.  "The  scamp!"  he  exclaimed  with  an 
angry  laugh;  "why  the  fellow's  worth  a  million. 
He  is  Jacobs,  the  great  clothier." 

By  the  time  my  rambling  talk  was  finished,  I 
observed  Scholasticus  glancing  often  and  furtively 
at  the  clock.  It  was  after  one,  but  Primrose's  turn 
had  come  and  he  was  not  to  be  moved  from  a  final 
word. 

"There  is  one  more  situation  about  which  I  want 
to  relieve  my  mind,"  he  said;  "but  it's  a  hopeless 
situation,  I  suppose.  I  refer  to  the  blackmailing, 
especially  by  women,  which  is  sure  to  come  near 
every  one  of  us  first  and  last.  You  don't  often  hear 
it  mentioned  because  its  details  don't  always  bear 
public  discussion.   We  all  know  of  the  cases,  how- 


66  A  Doctor's  Table  Talk 

ever;  and  we  know  that  from  trials  for  breach  of 
promise  the  results  run  all  the  way  down  the  scale 
of  horrors.  Honest  husbands  and  devoted  wives 
have  been  made  miserable  for  life,  and  families 
have  been  broken  up  by  such  devil's  doings;  and 
there  is  no  redress.  You  remember  how  one  of  our 
old  teachers  used  to  tell  us  never  to  submit  to  a 
call  from  a  strange  female  without  having  one's 
wife,  or  some  other  reliable  woman,  within  hearing. 
But  that's  not  always  practicable  for  country 
doctors.  It's  a  hard  problem,  and  perhaps  the  most 
maddening  part  of  it  is  that  one's  friends  smile 
wisely  and  think  there  must  be  *fire  where  there 
is  so  much  smoke.'  " 

"Tut,  tut,"  said  Ely,  yawning;  "we'll  hear  your 
story  to-morrow.  Primrose.  It's  after  one,  and 
Scholasticus  is  asleep." 


CHAPTER  IV 

Some  Doctors,  and  their  Troubles 

"Common  Sense,  Tact,  the  Sense  of  Humor; 
those  are  excellent  words,"  said  Primrose,  as  he 
reeled  in  a  final  bass,  "but  the  qualities  are  as  rare 
as  trout  in  January.  Here's  Phillpotts's  definition 
of  humor,  —  I'm  never  tired  of  it,  though  it's  been 
quoted  in  many  books:  'For  this  humor  is  an  ad- 
junct divine,  and  as  far  beyond  the  trivial  word  for 
it  as  "  Love  "  is  or  "  Charity."  No  definition  or 
happy  phrase  sums  it  correctly  or  rates  it  high 
enough;  it  is  a  balm  of  life;  it  makes  for  greater 
things  than  clean  laughter  from  the  lungs.  It  is  the 
root  of  tolerance;  the  prop  of  patience;  it  suflfers 
long  and  is  kind;  serves  to  tune  each  little  life-har- 
mony with  the  world-harmony  about  it;  keeps  the 
heart  of  man  sweet,  his  soul  modest.  And  at  the 
end,  when  the  light  thickens,  and  the  mesh  grows 
tight,  humor  can  share  the  suflfering  vigils  of  the 
sleepless,  can  soften  pain,- can  brighten  the  ashy 
road  to  Death' ";  with  which  apparently  irrelevant 
words  he  ceased  for  the  time  being.^ 


68  A  Doctor's  Table  Talk 

It  was  nearing  mid-June  and  we  were  fishing  in 
Squam  waters.  Our  anchored  boat  rocked  gently 
on  Bear  Cove.  Evening  was  falling.  Venus  glowed 
in  the  western  sky;  the  golden  glories  of  the 
sunset  failed.  Shadows  stretched  far  across  the 
ripples;  and  the  darkening  slopes  of  the  Rattle- 
snakes lowered  in  mystic  gloom.  To  the  east,  Red 
Hill  still  held  a  gleam  of  day,  while  the  old  red 
farmhouse  at  its  foot  glimmered  with  welcome 
light. 

Primrose's  bass  was  landed,  the  boat  made  snug, 
the  anchor  raised ;  Ely  took  the  oars  and  sculled  us 
slowly  back  to  camp.  Our  quarters  consisted  of  a 
cozy  bungalow  near  the  head  of  the  cove,  in  a 
charming  grove  of  pines,  some  twenty  feet  above 
the  water.  We  kept  an  accommodating  New  Hamp- 
shire boy  about  the  place,  who  good-naturedly 
allowed  us  to  do  our  own  work,  while  he  himself 
threw  in  a  critical  remark  as  he  chewed  the  occa- 
sional straw. 

As  we  sat  about  our  camp-fire  that  evening. 
Primrose  began :  "  Some  of  us  doctors  have  a  strange 
sense  of  humor  and  a  very  odd  notion  of  science 
and  scientific  men.  The  best  of  us  are  unfettered 
and  are  doing  good  things,  but  some  of  the  con- 


Some  Doctors^  and  their  Troubles  69 

servative  ones,  who  preside  in  high  places  and  are 
called  'professors,'  are  certainly  remarkable  beings. 
You  have  observed  how  they  sit  smug  and  snug, 
and  teach  the  old  platitudes  and  quote  the  old 
text-books  until  progress  has  gone  by,  when  with  a 
groan  they  catch  on  as  the  last  car  whirls  past; 
not  that  most  of  them  are  wedded  to  tradition 
and  the  doings  of  former  generations ;  they  are  not. 
They  know  nothing  of  the  history  of  medicine,  but 
they  think  they  learned  something  day  before  yes- 
terday, and  they  don't  want  to  be  bothered  with 
unlearning  it." 

"  What  are  you  driving  at  ? "  queried  Ely.  "  Some 
one  in  office  has  been  abusing  you.  Teachers  of 
medicine  are  n't  so  bad.   I  was  once  one  myself." 

"Yes,  and  they  pushed  you  out.  Listen  to  this 
yarn:  A  friend  of  mine  has  a  jolly  little  ten-year- 
old  boy,  whom  I  have  known  since  his  birth.  He 
has  always  been  strong  and  active,  but  excitable. 
Three  years  ago  he  had  two  or  three  convulsions  in 
the  night,  but  nothing  characteristic.  The  family 
doctor  was  away  on  his  summer  vacation;  so  the 
child's  parents  began  the  usual  dreary  round  of 
calls  on  specialists.  They  consulted  three  or  four 
neurologists  and  pediatrists;  they  were  told  that 


70  A  Doctor's  Table  Talk 

the  case  was  clearly  epilepsy,  and  the  outlook  bad; 
that  there  was  nothing  to  do  but  to  diet  the  boy, 
keep  him  quiet,  and  dose  him  with  bromides.  No 
one  gave  any  real  sympathy  or  help.  No  one  said, 
*Put  your  burden  on  me;  I'll  try  to  carry  it  for  you; 
and  if  I  can't  help,  I'll  find  some  one  who  can.' 
Nothing  of  the  sort.  There  was  plenty  of  service 
in  it  all,  but  no  humanity.  The  parents  were  pa- 
tient, confiding,  and  sincere,  but  that  did  not  count. 
Finally  they  fell  into  the  hands  of  a  good  fellow, 
Dr.  James  (and  mind  you,  all  these  men  were  good 
fellows  in  the  ordinary  sense),  who  personally  and 
solicitously  looked  after  the  child  for  two  years. 
He  furnished  a  competent  nurse,  regulated  the 
boy's  diet  and  exercises,  gave  the  necessary  medi- 
cines, and  kept  him  in  the  country.  There  was 
great  improvement,  and  we  began  to  think  that  the 
trouble  was  superficial,  after  all.  Then,  a  month 
ago,  there  were  two  more  slight  convulsions.  When 
he  heard  of  them  the  good  fellow  of  a  doctor  lost 
heart  and  gave  his  final  verdict  of  hopeless  'ideo- 
pathic'  epilepsy,  whatever  that  means.  The  boy's 
father,  who  had  been  doing  some  thinking  on  his 
own  account  for  more  than  two  years,  suggested 
that  there  are  many  obscure  epilepsies  with  cause 


Some  Doctors y  and  their  Troubles  71 

unknown;  that  a  case  of  epilepsy  due  to  congenital 
misplacement  and  obstruction  of  the  bowel  re- 
cently had  come  to  his  knowledge,  after  apparent 
cure  had  followed  appropriate  treatment  of  the 
bowel;  and  he  suggested  X-ray  examinations  to 
determine  the  anatomy  of  his  own  boy's  vitals. 

"What  do  you  suppose  our  confrere  answered? 
That  such  examinations  are  of  absolutely  no  use; 
that  they  show  nothing;  that  they  lead  to  no- 
thing; and  that  they  merely  encourage  false  hopes. 
Does  n't  it  make  you  want  to  hide  your  diminished 
head,  after  all  the  enlightening  work  that  has  been 
done  on  poisoning  from  misplaced  vitals?  Poor 
James !  Osier  is  right.  We  pass  by  early  the  enthu- 
siasm for  new  knowledge.  At  forty-five,  James  is 
already  an  old  fogy.  He  knows  literally  nothing 
about  this  new  work;  so  he  says  it's  *no  good.' 
What's  worse,  he  does  n't  want  to  know.  He's 
simply  a  competent  old-time  routlnist  and  he'll 
never  be  anything  more.  You  can't  blame  him. 
He  has  reached  the  limit  of  his  little  tether;  but 
you  can  blame  the  system.  It's  the  same  old 
situation  at  which  Scholasticus  growls,  and  it  will 
never  be  better  until  we  have  that  cooperation  of 
which  prophets  tell.   As  for  the  proposition  made 


72  A  Doctor's  Table  Talk 

to  James,  —  there  may  be  something  in  it  or  there 
may  be  nothing.  The  maddening  thing  is  that  he  is 
unwilling  to  consider  it  at  all.  Why?  Because  it  is 
new." 

"Of  course,  James  is  a  fair  sample  of  a  common 
enough  type,"  replied  Ely;  "but  of  late  you  have 
seemed  to  me  altogether  too  pessimistic  in  your 
talk  about  the  profession.  You  know  quite  well 
that  as  a  group  of  men  our  ethics  are  sound  and  our 
standards  high.  And  I  believe  that  our  best  stan- 
dards are  maintained  by  you  country  doctors. 
Buncombe  and  pretension  irritate  you,  and  at  such 
things  we  city  men  are  the  worst  offenders.  Look  at 
our  friend  Scriba  here.  He  writes  a  very  decent  sort 
of  a  book  on  surgery,  and  gives  it  to  a  bustling 
firm  of  commercial  publishers,  who  string  the 
country  with  a  series  of  flapdoodle  advertisements, 
setting  forth  the  virtues  of  Scriba's  very  common- 
place book.  Listen  to  this,  —  I  have  the  journal 
here:  'A  Surgery  that  is  different.  It  is  in  every 
particular  up  to  date,  and  shows  that  rare  quality 
of  accentuating  the  essential  and  omitting  the 
unnecessary,'  etc.,  etc.,  etc.  Of  course  that's  rub- 
bish. No  self-respecting  scientific  man  wants  to  be 
shown  up  in  such  a  light.    Imagine  the  wrath  of  a 


Some  Doctors,  and  their  Troubles  73 

Warren  or  a  Huxley  at  finding  himself  so  adver- 
tised. Here  is  a  worse  one  still,  booming  the  per- 
sonal clinical  work  of  a  well-known  surgeon. 

"*A  skilled  operator,  a  natural  diagnostician, 
and  a  forceful  teacher  —  the  qualifications  pos- 
sessed by  Dr.  Smilax  In  the  highest  degree  —  make 
his  Surgical  Clinics  the  greatest  piece  of  publishing 
ever  undertaken.  They  deal  almost  exclusively 
with  diagnosis  and  treatment.  These  Clinics  are 
published  just  as  delivered  by  Dr.  Smilax.  In  this 
way  they  retain  all  that  individual  force  and  charm 
so  characteristic  of  the  clinical  teaching  of  this 
distinguished  surgeon.  But  the  most  vital  point 
about  these  Clinics  is  that  they  are  absolutely  fresh. 
They  are  surgery  —  right  down  to  the  minute, 
published  practically  as  soon  as  delivered.  There 
is  no  stale  matter;  everything  Is  new,  never  having 
appeared  in  print  before,  and  never  will  appear  in 
print  except  In  this  form.  Further,  you  can  rest 
assured  that  here  are  facts — facts  only:  definite 
points  in  diagnosis;  concise,  crisp  directions  in 
operative  technique.  .  .  .  Subscribe  to-day. "* 

"You  may  say  that  all  this  is  merely  the  work  of 
a  vulgar-minded  publisher,  who  knows  something 
of  human  nature  and  exploits  the  medical  profes- 


74  ^  Doctor^ s  Table  Talk 

sion  for  his  own  pocket.  And  yet  we  are  not  alto- 
gether blameless.  We  try  to  be  consistent,  but  we 
sometimes  wind  up  by  being  silly.  Our  most  re- 
presentative medical  journal  abolishes  advertise- 
ments of  many  proprietary  medicines  because  they 
are  humbugs,  while  it  gives  its  most  conspicuous 
page  to  such  personal  advertising  gabble  as  I  have 
just  read  to  you. 

"These  are  extraneous  things,  though,  as  is  much 
of  which  Primrose  complains.  At  bottom  doctors 
are  a  remarkably  clean,  honest,  straightforward  lot. 
We  live  too  near  the  facts  of  life  to  mistake  garbage 
for  gold.  Every  generation  furnishes  its  Walter 
Reeds;  and  the  life  of  one  such  man  steadies  every 
private  in  our  ranks. 

"Here's  a  little  story  that  came  to  me  only  last 
week.  We  all  recognize  the  sort  of  thing.  Young 
Coit  was  a  student  of  mine  some  four  years  ago. 
He  hailed  from  one  of  those  small  midland  cities, 
where  plain  living  and  high  thinking  don't  count 
for  much.  Coit's  father  was  a  prosperous  busi- 
ness man,  who  wanted  his  son  to  have  the  best 
possible  education  in  medicine.  There  was,  be- 
sides, a  mother  and  four  younger  sisters.  The  son 
was  always  a  serious,  hard-working  fellow,  but  no 


Some  Doctors,  and  their  Troubles  75 

prig.  He  was  an  oarsman,  was  well  read  in  general 
literature,  and  had  been  graduated  with  distinc- 
tion from  Yale.  From  the  beginning  of  his  medical 
course  he  showed  unusual  powers;  his  anatomi- 
cal dissections  were  of  the  best;  his  grasp  of  the 
meaning  of  physiological  problems  was  surprising; 
and  equally  so  was  his  sympathetic  interest  in 
allied  subjects.  While  a  student  he  traveled,  visit- 
ing other  laboratories.  He  was  no  blind,  contracted, 
satisfied  routinist,  but  showed  a  breadth  and  a 
comprehension  which  delighted  his  teachers,  when 
it  did  not  stagger  them.  At  the  same  time  he  kept 
up  his  French  and  German  reading,  nor  did  he  neg- 
lect current  English  literature.  When  he  chose  he 
wrote  charming  verses;  yet  he  was  no  paragon,  and 
the  other  students  made  him  their  class  president. 
He  took  no  interest  in  marks :  he  mastered  subjects. 
Of  course  he  was  a  conspicuous  man  through  his 
student  years,  but  he  was  graduated  in  medicine 
third  only  in  a  class  of  sixty-three.  By  that  time  he 
had  made  up  his  mind  to  devote  himself  to  research, 
for  especially  interesting  to  him  were  the  problems 
of  surgical  physiology.  To  make  sure  of  himself, 
however,  he  pushed  on  with  clinical  work  for  a 
time.  He  went  through  the  interne  courses  of  two 


76  A  Doctor's  Table  Talk 

general  hospitals,  with  credit,  and  then  for  a  year 
he  held  a  position  in  the  Rockefeller  Hospital  in 
New  York.  That  satisfied  him,  and  so  he  went  to 
Europe  where  he  spent  three  profitable  years  grind- 
ing at  his  physiology  in  Berlin  and  London.  Is  it 
not  a  satisfying  story.?  Who  could  ask  for  him- 
self or  for  his  son  a  more  stimulating  career  so 
far.f*  Wherever  he  went,  Coit  made  himself  felt, 
and  already  he  had  published  two  significant 
papers. 

"Three  months  ago  the  crash  came.  His  father 
died  insolvent,  and  Coit  was  called  home  to  take 
care  of  his  mother  and  sisters,  who  are  as  penniless 
as  himself.  He  has  settled  down  in  his  native  town 
to  practice  general  medicine,  and  to  help  support 
those  five  unhappy  women.  Perhaps  he  finds 
humor  in  the  situation.  Certainly  his  neighbors 
see  nothing  hard  in  it,  nor  do  they  understand  the 
kind  of  man  who  has  come  among  them.  Last 
week  I  went  out  to  see  him.  The  tale  of  personal 
hardship  which  had  reached  me  seemed  too  bad  to 
be  accepted  —  to  say  nothing  of  the  loss  to  science. 
I  found  him  —  as  you  would  expect  to  find  such  a 
man  —  doing  his  duty,  and  doing  it  superbly.  His 
mother  is  a  peevish  invalid,  who  has  no  confidence 


Some  Doctors,  and  their  Troubles  77 

in  her  son  or  his  'notions.'  She  keeps  a  futile 
osteopathist  hanging  about.  However,  Coit  has 
one  sister  who  is  a  fine  girl.  I  spent  a  half-hour  in 
his  waiting-room,  and  heard  the  usual  talk  of  his 
few  patients,  excusing  themselves  to  each  other 
for  employing  such  a  youthful  doctor.  I  talked 
with  one  of  his  father's  old  friends,  who  informed 
me  that  he  thinks  young  Coit  will  get  along;  that 
already  he  has  a  few  patients,  and  that  his  business 
will  look  up  when  old  Dr.  Bloodgood  retires. 
Fancy  it!  —  Coit,  a  favorite  pupil  of  Senn  and  the 
friend  of  half  the  physiologists  of  Europe!  Yes; 
he'll  get  along,  and  you  will  hear  of  him  yet,  if  he 
lives,  and  his  cortex  keeps  on  working." 

"Of  course,"  said  Primrose,  delightedly  walking 
up  and  down  and  furiously  rumpling  his  hair, 
"there  are  heroes  in  every  profession,  in  none  more 
than  in  medicine.  I  must  meet  that  young  Coit, 
and  know  more  about  him.  But  is  it  not  surprising 
how  the  English-speaking  world  even  yet  ignores 
or  underestimates  scientists  as  well  as  literary  men? 
Lister  is  the  only  English  doctor  ever  given  a  peer- 
age. Macaulay  got  his  barony  as  a  politician,  not 
as  a  historian.  Thank  God,  though;  the  fools  are 
not  all  dead.  They  help  to  keep  us  guessing.  But 


78  A  Doctor's  Table  Talk 

such  a  story  as  Coit's  renews  one's  confidence  in 
human  nature." 

It  is  a  mistake  to  suppose  that  doctors  have  no 
hobbies.  They  have  as  many  interests  as  most 
men,  in  these  days  of  narrow  interests;  and  their 
hobbies  are  generally  of  a  wholesome  kind.  To 
shooting  and  fishing,  commonly,  are  they  addicted, 
especially  in  middle  life;  while  tennis  and  baseball 
are  the  joys  of  many  in  their  earlier  years.  Nor  are 
the  fishing  doctors  of  the  contemplative  Izaak 
Walton  type,  given  to  fishing  because  thus  they 
may  find  time  to  dream  and  philosophize;  indeed, 
I  find  that  few  doctors  have  heard  of  the  immortal 
linen  draper,  or  know  whether  or  not  he  spelled 
"The  Compleat  Angler"  with  or  without  the  a. 
The  doctors  fish  zealously  for  the  sport  of  the  thing, 
with  all  the  lusty  joy  of  their  ancestors,  —  happy 
in  the  number  of  their  catch,  and  mendacious  as 
other  mortals,  when  they  describe  their  exploits. 

I  have  often  observed  that  doctors  are  gregarious. 
They  have  no  love  of  solitude  or  midnight  oil. 
They  are  given  much  to  marriage  feasts,  to  eating 
and  drinking,  and  to  relaxing  themselves  in  season. 
This  fishing  business  especially  fits  them.    They 


Some  Doctors,  and  their  Troubles  79 

remove  themselves  to  remote  places,  with  others  of 
their  kind.  They  fish,  they  lead  the  simple  life, 
and  they  gossip.  The  implied  oath  of  secrecy  and 
silence  in  their  relations  with  mankind  in  general 
is  omitted  in  the  case  of  trusted  fellow  craftsmen ; 
the  problems  and  experiences  and  trials  of  the 
daily  round  are  poured  flooding  over  the  patient 
comrade,  who  listens  or  not  as  he  awaits  his  turn. 

On  one  particular  evening  of  our  week  at  Squam, 
Primrose  was  especially  loquacious.  He  had  just 
returned  from  a  meeting  of  the  American  Medical 
Association  in  Atlantic  City,  and  was  full  of  his 
experiences.  There  was  little  conversation  that 
night.   It  was  all  monologue. 

Primrose  loquitur,  with  feeble  gasps  of  assent  or 
dissent  from  his  audience:  — 

"Of  course  every  properly  qualified  doctor  in 
America  should  belong  to  the  Association.  These 
meetings  are  wonderful.  They're  a  liberal  educa- 
tion. Outside  of  national  politics,  and  Washing- 
ton, there's  nothing  like  them.  I've  been  to  your 
Chautauquas  and  Church  Triennials.  They're 
froth  and  nursery  tales  in  comparison.  The  gener- 
ation just  ahead  of  us  did  us  a  great  wrong  when 
they  belittled  the  meetings  of  the  A.M.A.    I  re- 


8o  A  Doctor's  Table  Talk 

member  old  Dr.  Grimm's  once  saying  to  me,  *  Don't 
be  fooled  by  all  this  talk;  and  don't  mix  yourself 
up  with  that  crowd.  They're  nothing  but  a  parcel 
of  advertisers.'  Whatever  they  may  have  been 
once,  they're  primarily  nothing  of  the  sort  now; 
and  remember  that  the  Association  was  started, 
and  was  run  for  years,  as  it  is  now,  by  our  most 
representative  men.  The  whole  thing  is  certainly 
very  well  done  to-day,  and  I'm  always  preaching 
to  the  younger  men  that  they  should  never  miss 
these  meetings.  Of  course  I'm  an  old  country 
duffer,  but  I  confess  that  I  'm  full  of  excitement  and 
interest  from  the  moment  I  reach  the  station  plat- 
form. It's  stimulating  to  see  hundreds  of  men  all 
bent  on  the  same  errand  as  one's  self;  it's  delight- 
ful to  meet  dozens  of  old  friends,  and  I  confess  that 
I  often  rejoice  to  shake  the  hand  of  some  much- 
talked-of  man  from  Europe  who  has  come  here  to 
tell  us  what  he  knows.  I  always  try  to  reach  the. 
convention  twenty-four  hours  early,  and  I  spend 
that  free  day  going  about  among  the  men,  watch- 
ing the  arrivals,  and  visiting  the  House  of  Dele- 
gates. That  first  evening  fills  me  with  delight  as  I 
sit  in  the  corridor  or  smoking-room.  What  a  chance 
to  study  types  and  character!  I  am  growing  rather 


Some  Doctors,  and  their  Troubles  8i 

skillful  as  an  interpreter,  and  claim  that  I  can  tell 
roughly  the  region  from  which  a  man  hails,  unless 
he  is  a  very  recent  importation  there.  There's  one 
type  that  especially  interests  me,  and  I*m  coming 
to  think  it  may  some  day  become  the  common 
American  type,  just  as  Brother  Jonathan  and  the 
Yankee  farmer  were  once  the  type.  These  newer 
characteristic  men  come  from  the  Middle  West  — 
the  Mississippi  Valley  mostly.  Among  politicians, 
look  at  W.  J.  Bryan,  Champ  Clark,  Chairman 
Mack,  Urey  Woodson,  and  perhaps  Underwood 
and  Folk.  They  are  mostly  large,  heavy,  stooping 
men,  somewhat  paunchy,  who  have  not  learned 
properly  to  walk  or  to  carry  themselves,  —  their 
immensely  productive  and  laborious  lives  being 
given  up  to  other  activities.  See  their  clean-shaven 
faces,  their  compressed,  down-drooping  mouths, 
and  their  keen,  earnest,  tired  eyes. 

"I  saw  hundreds  of  such  among  the  doctors  a^t 
Atlantic  City  last  week;  and  I  heard  many  of  their 
stories.  Sometimes  it  seems  as  though  they  be- 
longed to  a  different  race  from  us  pampered  East- 
ern men.  They  come  mainly  from  the  farm  and  the 
village  store.  I  know  one  fine  fellow  who  started 
in  life  as  a  veterinary  surgeon;  and  another  splen- 


82  '       A  Doctor's  Table  Talk 

did  useful  chap  with  an  enormous  surgical  practice, 
who  traveled  Michigan  in  his  buggy,  peddling 
patent  medicines  until  he  was  thirty  years  old. 
Then  some  one  persuaded  him  to  study  real  medi- 
cine. A  friend  of  mine,  one  of  the  most  conspicu- 
ous surgeons  north  of  the  Ohio  River,  started  out 
to  be  a  doctor  thirty  years  ago.  His  father  was  a 
small  farmer  up  north.  He  himself  knew  nothing 
of  the  game  he  was  undertaking;  so  he  consulted 
their  old  family  doctor.  Now  it  happened  that 
their  old  family  doctor  was  a  homoeopathist  and  a 
graduate  of  a  third-rate  homoeopathic  medical 
school  in  St.  Louis.  Thirty  years  ago  that  school 
was  on  the  verge  of  collapse,  but  my  friend  knew 
nothing  of  all  that.  He  did  not  know  that  there 
was  any  difference  between  a  homoeopathist  and 
any  other  doctor.  He  looked  on  his  old  friend  as 
the  source  of  all  wisdom  in  matters  medical,  and 
so  by  his  advice  he  went  to  the  homoeopathic 
school.  Of  course,  his  preliminary  education  was 
practically  nothing.  At  the  end  of  two  years  he 
was  graduated,  and  began  a  country  practice  near 
Chicago.  He  is  a  man  of  great  ambition  and  bound- 
less curiosity  in  scientific  matters.  He  reads.  Very 
soon  he  discovered,  as  he  put  it  to  me,  that  he  was 


Some  Doctors,  and  their  Troubles  83 

in  the  wrong  crowd;  and  certainly  that  was  the 
wrong  crowd  thirty  years  ago.  He  found  that  he 
was  not  in  proper  touch  with  wide  medical  pro- 
gress; that  his  associates  did  not  interest  him;  that 
he  was  not  eligible  for  the  American  Medical 
Association;  and  that  his  special  school  was  un- 
known or  unrecognized  outside  of  a  small  radius. 
More  than  all,  he  perceived  that  he  himself  was 
an  ignoramus.  So  after  five  years  he  collected  his 
assets,  —  he  was  then  but  twenty-five,  —  went  to 
Germany,  spent  seven  years  at  grinding  work,  and 
then  returned  triumphantly,  with  an  education 
and  a  proper  degree  in  medicine;  while  besides  his 
conventional  education,  he  was  a  trained  man  who 
knew  how  to  use  his  knowledge.  Quickly  he  went  to 
the  front,  became  an  important  citizen,  and  has  long 
been  one  of  our  most  astute  surgeons,  as  you  know. 
"You  see  how  I  enjoy  looking  up  such  men  as 
that  year  after  year.  You  two  seem  to  lose  the 
human  side  of  our  annual  meetings.  You  run  on 
for  an  appointed  day  or  hour,  read  the  paper 
assigned  to  you,  and  then  take  a  night  train  for 
home.  You  should  go  as  I  go,  and  see  the  thing 
through.  So  you  get  the  spirit  of  the  affair.  You 
should  visit  the  different  sections  and  see  what  men 


84  A  Doctor's  Table  Talk 

are  doing  and  thinking.  Physiology  and  medicine 
are  as  important  as  chemistry  and  surgery. 

"  It  gives  one  a  thrill  sometimes  to  hear  a  really 
big  man  read  a  truly  great  paper.  I've  had  the 
experience  twice.  Last  year,  when  Browning  made 
his  announcement  of  finding  and  destroying  the 
cancer  parasite,  the  house  rose  to  him  three  thou- 
sand strong,  and  that,  too,  though  it  was  the 
Surgical  Section  which  knew  that  the  discovery 
meant  a  serious  loss  of  business  for  them. 

"Then  there's  the  machinery  at  work  all  the 
time,  to  keep  going  these  meetings  and  the  Associ- 
ation itself.  If  you  stop,  look,  and  listen  you  can 
sometimes  hear  the  wheels  creaking  and  groaning. 
The  mere  preparation  for,  and  conduct  of,  such  a 
congress  is  a  tremendous  job,  and  keeps  the  local 
committee  busy  for  six  months  or  more.  But  be- 
yond that,  there's  always  the  burning  question  of 
electing  officers,  —  especially  the  president  of  the 
Association.  There's  sometimes  as  much  election- 
eering, wire-pulling,  and  marshaling  of  delegates 
as  though  the  poor  man  were  going  for  four  years 
to  the  White  House.  He  must  be  of  the  proper  age 
and  the  proper  distinction,  and  from  the  proper 
geographical  region.  He  must  not  be  too  able  or  too 


Some  Doctors f  and  their  Troubles         85 

distinguished;  though  able  men,  to  their  own  sur- 
prise, do  sometimes  sHp  in;  and  above  all,  it  must 
be  shown  that  he  has  trodden  on  no  one's  corns. 
Then  there  are  the  followers  to  be  reckoned  with, 
and  the  rivals  to  be  placated  with  the  promises  of 
future  office.  Oh,  it's  a  grand  game.  But  after  all, 
it's  harmless.  It  is  one  method  of  honoring  a  popu- 
lar man,  while  all  the  time  the  real  power  rests  in 
the  trustees,  as  we  call  the  executive  committee. 

"Those  trustees  are  very  important  people,  yet 
I  suppose  that  scarcely  one  member  in  five  hun- 
dred of  the  Association  knows  anything  about 
them.  They  seem  to  combine  both  legislative  and 
executive  functions;  they  originate  all  sorts  of  new 
activities,  keep  a  rein  on  what  is  going  on,  and 
appropriate  the  necessary  moneys.  We  forget  that 
the  Annual  Meeting  stands  for  a  part  only  of  the 
work  of  the  Association.  The  trustees  and  the 
various  standing  committees  —  like  committees 
of  Congress  —  are  busy  throughout  the  year  con- 
sidering all  sorts  of  most  important  questions,  — 
of  legislation  and  expediency,  of  public  health  and 
instruction,  of  medical  education,  of  pharmacy 
and  chemistry,  and  a  dozen  other  similar  topics. 
But  I  've  bored  you  enough." 


86  A  Doctor's  Table  Talk 

"No,"  said  the  always  polite  Ely,  rubbing  his 

eyes,  "but  I  think  we  were  to  climb  Red  Hill  at 

four  to-morrow  morning. 

" '  Sweet  Phosphor,  .bring  the  day; 
Light  will  repay 
The  wrongs  of  night; 
Sweet  Phosphor,  bring  the  day.* " 

As  we  sat  on  the  top  of  the  mountain  the  next 
morning,  munching  our  simple  breakfast  and 
watching  the  sun  climb  up  from  among  the  hills, 
Ely  turned  suddenly  to  Primrose  and  asked  what 
he  thought  of  Bernard  Shaw. 

"Almost  a  genius,"  was  the  answer;  "but, 
please  Heaven,  his  works  will  perish  with  him.  At 
the  worst,  a  piping  jigster  of  narrow  vision,  his 
experiences  are  really  few.  He  has  no  true  know- 
ledge of  men  or  of  the  world  we  live  in.  Can  you 
imagine  Shaw  rejoicing  in  this  glorious  sunrise? 
He's  a  yellow  journalist  in  literature.  He's  a  mere 
critic,  —  and  of  a  cheap  type,  in  spite  of  his  clever- 
ness. You  can't  think  of  him  as  creating  anything. 
Near-sighted  people  will  speak  of  him  as  dangerous 
until  the  end  of  his  little  day,  —  for  he's  a  splendid 
liar  and  vastly  amusing,  —  and  then  we'll  forget 
him,  as  fast  as  we  can.   Let's  not  talk  of  Shaw.'* 


Some  Doctors,  and  their  Troubles         87 

"It*s  a  letter  I  got  yesterday  that  suggested 
Shaw.  The  writer  quoted  one  of  Shaw's  unkind 
remarks  about  doctors,  and  then  went  on  to  tell 
of  Bumstead's  lawsuit.  He's  been  sued  for  mal- 
practice by  a  charity  patient.  I  heard  a  lot  about 
it  before  leaving  home;  —  indeed  I  was  one  of  his 
witnesses." 

Primrose  absently  signified  his  willingness  to 
listen;  so  Ely  continued. 

"There  are  one  or  two  points  in  the  case  that 
are  fundamental  or  vital.  The  matter  at  issue 
hangs  largely  on  the  question  of  an  employer's  or 
surgeon's  liability,  in  these  days  of  intricate  oper- 
ating or  elaborate  *team  play,'  as  they  call  it. 

"Here's  the  clinical  story  of  the  case  as  told  to 
the  jury:  Some  three  years  ago  a  poor  devil  of  an 
Italian  cobbler  had  an  attack  of  gall-stone  colic 
in  the  middle  of  the  night.  (Query;  who  ever  heard 
of  an  Italian  cobbler  before?)  He  described  his 
sufferings  in  harrowing  detail.  No  doubt  they  were 
severe,  for  he  certainly  became  a  very  sick  man. 
The  great  pain  subsided,  somewhat,  after  a  day, 
but  he  was  left  with  a  fever  and  much  soreness.  He 
was  then  sent  by  his  doctor  to  a  hospital  where 
Bumstead  was  the  surgeon  on  duty.    Two  days 


88  A  Doctor's  Table  Talk 

later,  Bumstead  operated;  removing  gall-stones 
and  draining  a  badly  infected  gall-bladder.  It  was 
a  nasty  case,  and  the  patient  had  a  close  call. 

"The  wound  did  not  heal  well;  a  small  draining- 
sinus  remained  open  for  months.  The  man  said 
that  during  those  months  he  was  never  free  from 
pain,  which  is  unlikely,  of  course.  During  much  of 
this  time  the  patient  was  Bumstead's  private  char- 
ity patient  at  his  office.  Meanwhile  the  man  had 
become  a  qualified  chauffeur.  Finally  the  corpus 
delicti^  the  cause  of  the  lawsuit,  appeared;  the 
patient  got  rid  of  a  gauze  sponge  left  in  at  the  oper- 
ation. In  spite  of  this,  his  condition  did  not  im- 
prove materially.  The  wound  continued  open,  and 
finally  he  went  to  another  hospital,  where  after 
some  secondary  operation  the  wound  eventually 
healed.  Now  he  sues  Bumstead  for  leaving  the 
sponge  in  his  abdomen,  and  causing  him  a  year  of 
great  suffering;  and  he  sets  his  damages  at  ten 
thousand  dollars. 

"Of  course,  on  the  first  hearing,  any  unpreju- 
diced person  would  say  that  the  surgeon  was  at 
fault  and  should  be  made  to  suffer  in  his  turn;  but 
truly  I  think  that  such  judgment  would  be  wrong. 
Evidently  this  plaintiff  and  his  attorney  believed 


Some  Doctors,  and  their  Troubles  89 

they  had  an  easy  case,  for  they  called  no  experts, 
and  relied  entirely  on  the  unvarnished  statement 
of  facts;  nor  would  they  compromise,  but  pushed 
on  for  their  maximum  ten  thousand. 

"Unfortunately,  the  situation  of  *  sponge  left  in' 
is  no  new  one.  During  the  past  thirty  years  a  large 
number  of  these  cases  have  come  to  light.  Nearly 
every  considerable  operating  surgeon  has  had  one 
or  two;  and  in  regard  to  the  cases,  the  public,  and 
especially  the  courts,  should  ask  themselves  two 
questions:  how  serious  a  matter  is  this  for  the 
patient,  and  what  is  the  responsibility  of  the  sur- 
geon for  this  accident  or  negligence.  In  the  past, 
juries  have  divided,  or  have  found  for  the  plaintiff. 

"As  to  that  first  question,  of  damage  to  the 
patient,  most  of  the  evidence  goes  to  show  that  the 
damage  is  usually  not  great.  The  sponge  is  clean 
when  inserted;  through  the  action  of  the  body's 
tissues  it  is  soon  rolled  up  into  a  small  ball.  If  the 
sponge  is  connected  with  a  drained  wound,  it 
usually  keeps  that  wound  open  until  itself  is  dis- 
charged; or  if  left  in  a  tightly  closed  cavity,  the 
sponge  seeks  some  nook  where  it  lies  for  years 
without  doing  harm;  or  else  It  penetrates  one  of 
the  hollow  organs,  —  as  In  t;his  case,  —  and  so  is 


90  A  Doctor^ s  Table  Talk 

discharged.  It  may  occasionally  cause  a  little  pain 
or  discomfort,  but  the  cases  in  which  its  presence 
leads  to  serious  damage,  or  to  death,  must  be  rare. 
"Now,  think  for  a  moment  about  our  second 
question,  —  the  responsibility  of  the  surgeon. 
Is  he,  or  is  he  not,  to  be  held  responsible  for  such  a 
calamity  as  *  sponge  left  in'?  and  if  not  he,  then, 
who  is  responsible."*  It  seems  as  though  the  best 
way  to  get  at  our  answer  would  be  to  consider  the 
conditions  under  which  modern  operations  are 
done.  The  conditions  are  mostly  quite  new,  and 
little  understood  by  the  public,  though  the  methods 
employed  are  now  in  a  general  way  much  the  same 
the  world  over.  These  conditions  are  greatly  dif- 
ferent from  what  they  were  a  few  years  ago;  and 
that  is  a  fact  which  juries,  and  even  judges,  find 
it  hard  to  understand.  A  few  years  ago,  the  surgeon 
himself,  alone,  practically  unsupported,  was  every- 
thing in  an  operation.  Tradition  and  fiction  are  full 
of  familiar  situations.  Even  Ian  Maclaren,  in  *The 
Bonnie  Briar  Bush,'  brings  to  the  Highlands  a  great 
London  surgeon  bearing  in  his  hand  a  trifling  bag 
of  instruments,  and  without  an  assistant.  He  brings 
him,  too,  to  perform  a  singularly  difficult,  life- 
saving  operation.    Indeed,  old-time  surgeons,  in 


Some  Doctors,  and  their  Troubles  91 

the  ancient  bad  days  when  wound-fever  and  death 
were  the  common  results  of  operating,  —  old-time 
surgeons,  with  their  slender  equipments,  were  solely 
responsible.  Themselves  surgically  unclean,  they 
operated  with  unclean  instruments,  in  unclean  sur- 
roundings, on  unclean  patients.  Mostly  the  oper- 
ations were  simple;  body  cavities  seldom  were 
opened;  all  operations  were  rare,  and  all  were 
momentous :  the  surgeon  did  everything  himself  — 
cutting,  sponging,  tying,  sewing.  He  was  respon- 
sible for  every  step,  and  he  alone.  If  anything 
went  wrong,  it  went  wrong  under  his  own  eye  and 
hand.  So  the  courts  properly  held;  no  employers' 
liability  applied  to  the  surgeon  in  those  days,  for 
the  operating  surgeon  was  not  an  employer  in  our 
present  sense. 

"Look  now  at  the  conditions  of  a  modern  oper- 
ation. The  surgeon  is  still  the  central  figure,  for  the 
surgeon  initiates  all  the  moves,  and  gets  whatever 
glory  or  cursing  'Is  coming.'  But  a  well-conducted 
modern  operation  Is  as  much  a  piece  of  team  work 
as  Is  a  well-played  football  game.  Consider:  the 
progress  of  the  operation  has  begun  twenty-four 
hours  or  more  before  the  patient  goes  to  the  oper- 
!atlng-table.    Nurses  put  him  through  a  process  of 


92  A  Doctor's  Table  Talk 

dieting,  scrubbing,  and  cleansing.  An  anaesthetist 
studies  him  and  advises  about  the  anaesthetic  and 
the  subordinate  drugs.  If  all  is  done  well,  the 
patient  is  brought  to  the  operating-room  with  mind 
and  body  in  the  best  condition  for  the  job.  The 
anaesthetist  continues,  and  produces  in  him  uncon- 
sciousness with  the  most  suitable  drugs.  The  pa- 
tient is  then  taken  in  hand  by  the  house  surgeon 
and  his  assistants,  who  again  scour  and  cleanse 
him,  and  pack  him  in  sterile  wrappings.  So  much 
for  the  patient  himself.  All  other  persons  concerned 
with  the  operation  must  be  prepared  with  equal 
care,  —  the  surgeon,  the  first  assistant,  the  second 
assistant,  the  one  or  two  operating  nurses,  and  in  a 
large,  well-equipped  hospital,  other  subordinate 
assistants,  if  such  there  be.  Beyond  this  care  of  the 
individuals  concerned,  there  is  the  care  of  the  in- 
struments, dressings,  sponges,  ties,  stitches,  and 
other  apparatus.  In  a  trial  like  that  of  Bumstead's, 
all  this  must  be  made  clear  to  the  jury.  We  must 
consider  especially  in  his  case  the  question  of  the 
use  and  care  of  sponges.  They  are  confided  to  a 
nurse,  whose  chief  and  important  business  is  to 
keep  in  touch  with  them.  A  definite,  known  num- 
ber of  sponges  are  used.    They  are  divided  into 


Some  Doctors,  and  their  Troubles         93 

groups  or  bundles,  usually  of  six  sponges  each. 
A  counted  number  are  handed  out  by  the  nurse  to 
the  surgeon,  for  use  in  the  wound;  and  then,  after 
the  operation  is  over,  she  collects  them,  scores  up 
every  one,  and  to  the  surgeon's  regular  routine 
inquiry  announces  that  the  *  sponge  count  is  cor- 
rect,' or  some  such  phrase.  Of  course  this  announce- 
ment relieves  the  surgeon  of  any  anxiety  or  further 
responsibility,  regarding  the  fate  of  the  sponges. 
No  one  is  infallible,  however,  and  mistakes,  or  mis- 
counts by  the  nurse  sometimes  happen,  as  in  this 
case. 

"The  question,  then.  Is,  —  Who  Is  responsible 
in  the  present  case }  Obviously  and  primarily,  the 
nurse.  But  she  is  an  employee.  She  is  the  servant 
of  the  hospital.  There's  the  rub.  In  most  of  our 
public  hospitals,  as  at  present  conducted,  the  sur- 
geon has  no  voice  whatever  in  the  selection  of  his 
nurse  assistants.  He  may  have  something  or  every- 
thing to  say  about  the  subordinate  doctors  and 
student  assistants,  but  not  a  word  about  the 
nurses.  These  operating  nurses,  good  or  bad,  are 
thrust  upon  him.  He  must  suffer  for  their  errors, 
if  errors  there  be.  I  dare  say  this  is  all  unavoid- 
able; I  don't  know,  not  being  a  surgeon;  but  I  can 


94  A  Doctor's  Table  Talk 

see  how  it  must  put  every  surgeon  in  a  difficult 
position. 

"On  the  other  hand,  in  his  private  practice,  a 
surgeon  can  make  up  his  own  team  completely, 
selecting  and  training  his  own  operating  nurses. 
When  fully  developed,  such  private  teams  are  im- 
mensely superior  to  the  public  hospital  teams.  If  I 
make  my  point,  you  see,  then,  that  in  my  judgment 
the  public  hospital  should  be  held  responsible  for 
the  errors  of  its  nurses  in  public  hospital  operating; 
while  in  private  operating,  the  surgeon  should 
be  held  responsible.  This  question  is  fundamental, 
and  it's  a  great  shame  that  the  courts  don't  set- 
tle it.  In  Bumstead's  case  the  jury  disagreed,  — 
eleven  to  one  in  his  favor.  The  gossip  was,  later, 
that  the  one  juror  against  Bumstead  was  a  crank 
who  wanted  to  get  even  with  the  hospital  because 
his  wife  died  there  fifteen  years  ago.  Juries  are 
wonderful  things." 

"Good,  Ely,  good,"  said  Primrose,  after  a  pause. 
"You've  told  your  story  very  well.  But  I  can't 
help  feeling  sorry  for  that  poor  devil  with  a  sponge 
in  his  stomach." 


CHAPTER  V 
Dr,  Primrose  on  Women 

I  can't  escape  from  Primrose  and  his  enthusi- 
asms. He  has  an  enthusiasm  just  now  for  putting 
down  the  Woman  Suffrage  movement.  He's  a 
devoted  squire  of  dames  and  an  admirer  of  the  sex; 
but  the  suffrage  for  women,  with  all  it  implies,  is  a 
burden  which  he  thinks  they  should  not  be  com- 
pelled to  bear.  "Let  'em  vote,"  he  clamors,  "I 
dare  say  they'd  vote  no  more  stupidly  than  most 
men.  If  the  vote  were  all,  let  'em  have  it.  But  after 
the  vote  will  come  the  duties  of  public  office.  We 
shall  have  ill-conditioned  women  shrieking  to  be 
aldermen  and  mayors,  legislators  and  governors, 
judges  and  senators." 

For  myself,  I  am  inclined  to  think  that  Mr.  Roose- 
velt may  be  correct  when  he  writes :  "  I  do  not  re- 
gard the  movement  as  anything  like  as  important 
as  either  its  extreme  friends  or  its  extreme  oppon- 
ents think.  It  is  so  much  less  important  than  many 
other  reforms  that  I  have  never  been  able  to  take  a 
very  heated  interest  in  it."  I  believe  that  is  coming 


96  A  Doctor's  Table  Talk 

to  be  the  attitude  of  thousands  of  thoughtful  men. 
They  don't  altogether  like  to  see  women  taking 
part  in  public  life,  but  they  are  thinking  that  the 
experiment  may  be  worth  trying,  that  women  will 
tire  of  the  obligation,  and  that  probably  no  great 
harm  will  be  done.  Such  men  agree  with  Miss 
Tarbell  when  she  writes  ("Book  of  Woman's 
Power"),  in  substance:  "Men  and  women  have 
always  crawled  or  soared  together.  The  lot  of 
woman  is  hard,  but  the  human  lot  is  hard.  The 
assumption  that  the  improvement  of  woman's 
condition  depends  upon  the  vote  is  quite  as  un- 
sound as  the  charge  of  her  inferiority.  The  woman 
in  industry  is,  after  all,  but  a  transient.  A  training 
that  will  lead  her  to  apply  her  power  with  apprecia- 
tion and  enthusiasm  to  domestic  and  not  political 
life  is  what  she  needs.  It  is  harmful  and  unsound  to 
believe  that  woman's  position  in  society  would  im- 
prove in  proportion  as  her  activities  and  interests 
become  the  same  as  man's.  This  implies  that  man's 
work  in  society  is  more  important  and  developing 
than  woman's."  Again,  Mr.  Roosevelt  writes  this  re- 
freshing paragraph:  "Other  fools,  advising  women 
to  forsake  their  primary  duties  and  *go  into  indus- 
try,' prattle  about  the  'economic  dependence'  of 


Dr.  Primrose  on  Women  97 

the  wife.  Economic  dependence,  forsooth!  Any 
husband  who  regards  his  wife  as  *  economically- 
dependent/  or  who  fails  to  recognize  her  as  a  full 
partner,  needs  severe  handling  by  society  or  the 
state." 

With  such  thoughts  as  these  in  mind,  I  was 
somewhat  startled  by  Primrose,  who  was  full  of  his 
subject  when  he  rushed  in  upon  me  one  winter 
afternoon,  some  six  months  after  our  talk  on  Red 
Hill.  "My  friends  the  New  Hampshire  Progress- 
ives," he  informed  me,  "are  going  in  for  a  try  at 
Woman  Suffrage.  At  any  rate,  they  have  persuaded 
the  legislature  to  refer  the  question  to  the  voters. 
I  tell  you,  Scriba,  the  majority  of  women  aren't 
up  to  it.  It'll  be  too  much  for  'em,  and  they'll 
leave  the  voting  to  the  cranks  and  the  unfit." 

I  told  him  that  I  doubted  all  that;. but  in  order 
to  silence  his  clamor  I  asked  him  to  come  in  later 
to  dine  and  talk  it  out. 

"That  is  just  what  I  meant  to  propose,"  he  said. 
**Get  Ely.  I've  written  down  some  of  my  ideas, 
and  I  want  to  read  the  paper  to  you.  We  hear 
nothing  but  the  positive  side  of  the  argument  in  the 
public  press,  to-day.  Nothing  much  is  being  said 
about  woman's  psychology,  physiology,  and  evolu- 


98  A  Doctor's  Table  Talk 

tion.  The  editors  are  all  scared.  They  think  that 
it  is  liberal  and  progressive  to  shout  for  women's 
rights." 

And  so  that  evening  Ely  joined  us  at  dinner;  and 
the  ladies,  mildly  approving,  sat  with  us  while 
Primrose  read  his  piece. 

Some  Reflections  concerning  Woman's 
Suffrage 

By  Jonathan  Primrose^  M.D. 

"Arguments  flimsy  and  sound  on  both  sides  of 
the  interesting  question  of  granting  the  suffrage 
to  women  have  been  piled  high;  fists  have  been 
shaken  now  for  two  generations;  households  have 
been  made  miserable,  and  sex-antagonism  has  been 
created  for  the  first  time  in  the  history  of  the  human 
race.  Most  of  the  good  arguments  for  suffrage  are 
too  familiar  to  need  recalling,  for  they  are  founded 
on  the  much-quoted  authority  of  John  Stuart  Mill, 
to  the  effect  that  every  rational  adult  human  being 
should  have  a  voice  in  the  conduct  of  democratic 
government. 

"  In  this  connection  it  Is  interesting,  betimes,  to 
seek  some  perspective;  to  view  from  a  distance  the 
great  question  of  human  development  and  to  esti- 


Dr.  Primrose  on  Women  99 

mate  the  position  at  which  we  are  now  arrived,  — 
our  relation  to  the  past,  to  the  future,  and  to  the 
world  in  which  we  live.  To  the  mass  of  persons  in 
our  world  that  relationship  is  without  meaning: 
the  thought  is  as  though  it  were  not.  Everyday 
people  run  in  an  everyday  circle ;  their  feeble  notions 
are  bounded  by  their  native  town.  The  concentra- 
tion of  modern  life,  and  the  specializing  of  modern 
effort  curiously  contract  their  horizon. 

"The  other  day  a  clever  collegian  said  to  me: 
*What  shall  I  read.^  I  know  nothing;  I  am  like  a 
rat  in  a  barrel.'  The  man  in  the  street  is  in  even 
worse  case.  He  is  like  a  stranger  in  a  strange  city. 
You  cannot  make  the  New  Yorker  lose  himself  in 
New  York.  Hide  him  overnight  in  a  back  room  of  a 
hotel ;  and  for  a  moment,  when  looking  about  in  the 
morning,  he  may  be  confused,  but  quickly  he  finds 
himself.  From  his  window  he  recognizes  familiar 
landmarks.  He  is  on  Fifty-fourth  Street,  or  on 
Washington  Square,  as  the  case  may  be.  He  goes 
out  on  the  street ;  he  makes  his  way  uptown  or  down- 
town without  hesitation.  The  people  about  him 
have  the  accustomed  air;  they  suit  him;  he  knows 
what  is  going  on  in  his  little  world;  he  reads  his 
morning  paper;  he  rejoices  in  its  local  tone:  the 


lOO  A  Doctor'' s  Table  Talk 

name  and  doings  of  the  mayor,  of  the  police  com- 
missioner, of  the  latest  city  enterprise,  of  the  sub- 
way stations,  of  the  theatre,  —  all  these  things  are 
pleasant  to  him.   He  orientates. 

"But  take  this  same  honest  fellow  and  conceal 
him  overnight  in  a  back  room  of  a  hotel  on  Michigan 
Avenue,  Chicago,  —  a  city  unknown  to  him.  What 
now  are  his  morning  sensations?  He  looks  out  in 
confusion  upon  unknown  roofs.  The  strange  street 
carries  with  it  no  meaning;  he  knows  not  north  from 
south.  Within  five  minutes  of  the  door,  he  is  lost. 
The  faces  he  passes  signify  nothing;  he  pronounces 
the  morning  paper  a  narrow  and  provincial  sheet; 
he  knows  and  cares  not  for  the  concerns  of  this 
dreary  town;  the  shops,  the  elevated  road,  the 
buildings,  the  theatres  are  all  to  him  as  something 
vague  and  unfamiliar;  he  delivers  himself  into  the 
hands  of  the  nearest  police  officer  or  cabman,  and 
cries  aloud  for  the  railway  station  and  a  ticket  to 
New  York. 

"Equally  vague  are  the  notions  of  the  average 
citizen  regarding  the  land  in  which  he  lives.  The 
United  States  of  America  has  a  fine  sound  for  him. 
It  is  God's  own  country,  he  babbles ;  but  he  knows 
little  about  it,  and  nothing  of  the  lands  beyond  its 


Dr.  Primrose  on  Women  loi 

borders.  He  has  a  few  shadowy  ideas  about  Ameri- 
can geography.  With  the  aid  of  a  time-table,  a 
map,  and  a  Pullman  car  he  can  make  his  way  from 
Boston  to  Washington;  but  Washington,  when 
reached,  has  no  special  meaning  for  him.  He 
knows  it  is  the  capital  of  his  country,  the  great 
headquarters  of  democratic  government;  but  these 
are  mere  words.  He  knows  nothing  of  how  the  city 
came  into  existence,  of  its  architecture  and  its 
vicissitudes.  He  may  know  that  in  Washington  are 
to  be  found  the  President,  Congress,  and  the  Su- 
preme Court;  but  talk  about  the  nature  of  a  gov- 
ernment expressed  in  terms  of  an  executive,  a 
legislative  body,  and  a  court  to  interpret  the  laws 
and  the  constitution,  is  gibberish  in  his  ears.  He 
has  a  school-boy's  knowledge  of  his  country's  his- 
tory; of  a  Columbus;  of  a  George  Washington,  of  a 
cherry-tree  and  a  hatchet,  of  Puritans,  Indians,  a 
Boston  Tea-Party,  a  Fourth  of  July,  an  American 
Revolution,  bloody-minded  Tories,  and  a  wicked 
King  George;  but  for  the  life  of  him  he  cannot  tell 
you  what  it  was  all  about.  From  the  adoption  of 
the  Federal  Constitution  to  the  bombardment  of 
Fort  Sumter,  all  is  black  chaos  to  the  average 
American  citizen.    He  knows  that  the  Civil  War 


I02  A  Doctor's  Table  Talk 

was  about  freeing  the  negro  slaves ;  and  he  believes 
that  Lincoln,  Grant,  Sherman,  Jefferson  Davis, 
Grover  Cleveland,  Lee,  John  Brown,  Daniel  Web- 
ster, and  sundry  other  worthies  had  a  hand  in  it. 
He  brings  his  flabby  mind  down  to  modern  times, 
and  sees  about  him  a  seething  mass  of  ideas,  activi- 
ties, and  emotions  to  him  uncorrelated,  which 
leave  him  unimpressed,  or  dumb  and  gasping. 
What  shall  he  say  of  labor  unions,  of  the  'trusts,' 
of  political  parties,  of  national  leaders,  of  modern 
altruism,  of  the  great  democratic  and  socialistic 
movements  towards  human  betterment;  of  a  revo- 
lutionized Church,  of  modern  conceptions  of  human 
development,  human  life  and  human  destiny,  of 
all  that  modern  enterprise  in  the  arts,  in  science,  in 
invention  and  literature  is  bringing  to  twentieth 
century  men  and  women  t  The  average  citizen  has 
nothing  to  say  to  all  these  things.  They  flood  over 
him.  He  hears  a  name  now  and  again,  —  like  a 
great  bell  rung  beneath  the  waves ;  now  and  again 
he  rises  for  air;  he  sees  a  glimmer  of  truth;  he  hears 
a  word  spoken  in  his  own  interest;  he  nods  wisely 
his  head;  he  casts  his  foolish  vote;  he  shouts  his 
shout.  But  the  meaning  of  It  all  never  reaches  him. 
He  is  confused  and  puzzled  by  what  he  hears  and 


Dr.  Primrose  on  Women  103 

reads.  He  retires  smugly  to  his  hearth  and  his  daily 
bread,  and  he  tells  his  wondering  children  how  big 
and  foolish  and  naughty  is  this  world  and  the  things 
thereof. 

"  Such  is  the  average  citizen  and  voter,  —  the 
member  of  the  great  gray  mass,  —  swayed  back 
and  forth  by  impulse,  by  hysteria,  by  fancied 
interest,  by  demagogues,  anon  by  an  honest  man 
of  genius.  Such  are  the  masses,  the  millions,  whose 
votes  are  equally  divided,  who  impress  by  their 
quantity,  whose  quality  is  as  naught. 

"  They  are  not  the  true  rulers  and  governors  set 
over  us,  but  out  of  their  ranks  the  rulers  come.  From 
the  midst  of  the  chaos  there  is  tossed  to  the  surface 
now  and  again  a  superior  person,  —  a  man,  a  leader, 
a  governor.  Just  as  the  great  gray  mass  is  made  up 
of  all  sorts  and  conditions  of  men,  —  the  rich  and 
the  poor,  the  idle  and  the  toilers,  the  educated 
and  the  uneducated,  the  virtuous  and  the  vicious, . 
—  so  the  chosen  ones,  the  superior  persons  who  rise 
by  force  of  intellect,  come  from  no  special  class,  and 
represent  no  special  interest.  The  superior  ones 
gather  themselves  together  for  mutual  support  or 
offense;  they  control  and  direct  the  multitudes 
from  whom  they  sprang.  They  rule. 


I04  A  Doctor's  Table  Talk 

**  And  now  into  this  seething  mass,  into  this  stage 
of  human  development,  we  see  injected  the  ques- 
tion of  Woman  Suffrage.  This  question  is  becom- 
ing an  important  question.  There  may  or  may  not 
be  truth  in  the  oft-repeated  assertion  that  the 
woman's  vote  is  coming.  So  long  as  woman's  vote 
is  immersed  in  the  vote  of  the  great  mass,  it  will 
be  divided  and  have  little  influence,  for,  as  David 
Harum  said,  there  is  a  deal  of  human  nature  in  all 
of  us.  But  woman  would  not,  and  doubtless  should 
not,  be  content  with  such  a  situation.  The  more 
ambitious  women  will  strive  to  rise  to,  and  mingle 
with,  the  class  of  superior  men,  and  to  take  an 
active  part  in  affairs. 

"As  the  judicious  critic  hearkens  to  the  debate 
and  views  the  activities  of  Woman  Suffragists,  he 
is  often  impressed  by  the  feeling  that  most  of  these 
women  have  thrown  little  light  on  the  problem  of 
progress.  They  carry  a  feeble  candle  which  sheds  a 
narrow,  encircling  glimmer  on  the  road,  but  they 
fail  utterly  to  illuminate  the  broad  path  down 
which  civilization  has  marched,  and  they  fail  utterly 
to  show  us  the  highroad  on  which  we  are  advancing. 

"  What  is  It,  then,  that  women  so  boldly  and  con- 
fidently demand  ?  Nothing  less  than  an  equal  share 


Dr.  Primrose  on  Women  105 

in  the  conduct  of  government.  You  may  grant 
them  the  ballot  if  you  choose,  and  a  voice  in  the 
direction  of  local  personal  interests  which  touch 
them  nearly ;  —  in  the  direction  of  schools,  of 
municipal  hygiene,  of  factories,  and  the  like. 
Those  are  practical,  everyday  questions  which 
concern  the  immediate  comfort  and  well-being 
of  the  women  themselves,  and  women  have  long 
proved  the  value  of  their  services  in  these  fields. 
But  when  we  consider  admitting  the  women  to  an 
equal  share  with  men  in  great  affairs  and  in  the 
conduct  of  government,  shall  we  not  properly 
pause  and  ask  what  has  been  accomplished  by 
those  men  whom  women  would  rival  or  supplant, 
and  what  meantime  has  been  womarCs  contribution 
to  human  progress  ?  Be  it  said,  at  the  same  time, 
that  woman's  excuse  of  lack  of  opportunity  in  the 
past  is  a  fatuous  and  misleading  begging  of  the  ques- 
tion. The  Roman  slave  Epictetus  wrote  a  book  of 
philosophical  reflections  which  have  rejoiced  the 
ages  equally  with  the  philosophy  of  the  Roman  Em- 
peror, Marcus  Aurelius.  A  poor  Syrian  carpenter 
founded  a  system  of  ethics,  preached  a  philosophy 
of  life,  and  established  a  great  religious  system 
which  has  controlled  the  Western  world  for  nearly 


io6  A  Doctor's  Table  Talk 

two  thousand  years.  An  obscure  Dutch  mechanic 
invented  and  developed  a  system  of  multiplying 
books  which  has  revolutionized  civilization  and  has 
made  possible  the  march  of  human  progress.  But 
one  need  not  multiply  examples.  Most  of  the  great 
achievements  of  the  human  mind  have  been  accom- 
plished by  men  obscure,  down-trodden,  little  re- 
garded. The  prophet  and  genius  does  not  wait  for 
occasion  and  privilege.  He  makes  and  seizes  his 
own  opportunity.  He  rises  above  circumstance, 
and  the  world  hears  him  from  the  depths. 

"What,  then,  have  the  men  accomplished  through 
ten  thousand  years  of  progress  ?  They  have  invented 
and  established  civilization;  they  have  developed 
agriculture  and  commerce.  They  have  perfected 
navigation  and  transportation;  they  have  devel- 
oped a  world-wide  system  of  finance;  they  have 
invented,  if  they  have  not  perfected,  the  arts  of 
architecture,  sculpture,  painting,  and  music.  They 
have  conquered  and  colonized  the  world ;  they  have 
devised  and  perfected  a  glorious  literature,  they 
have  created  splendid  philosophies;  they  have 
adopted  and  formulated  great  religious  systems; 
they  have  conceived  of  honor  and  human  brother- 
hood, and  they  have  established  that  greatest  work 


Dr.  Primrose  on  Women  107 

of  man,  the  court  of  justice.  Through  the  spirit 
of  modern  altruism  they  have  sought  out  the 
down-trodden;  on  a  great  scale  they  strive  to  re- 
lieve the  afflicted;  they  have  established  popular 
education;  they  have  developed  scientific  medicine; 
they  have  immensely  mitigated  the  sufferings  of 
the  human  race;  they  have  developed  science  and 
invention;  they  have  explained  the  secrets  of  the 
earth,  and  the  history  of  the  past,  the  facts  of  na- 
ture, and  the  mystery  of  the  stars ;  they  have  con- 
ceived of  a  true  democracy,  and  they  have  estab- 
lished and  conducted  happily  great  systems  of 
beneficent  government. 

"These  are  no  small  matters;  the  record  is  far 
from  complete;  but  such  as  it  is,  the  work  is  the 
work  of  men,  and  of  men  only.  The  great,  prophetic, 
creative  master-minds  are  the  minds  of  men.  Wo- 
men's names  do  not  appear.  These  things  must 
needs  be  said.  It  is  in  the  face  of  such  overwhelm- 
ing facts  that  one  reflects  on  the  mingled  pathos 
and  audacity  of  some  of  the  Suffragists'  demands. 

"  It  will  be  protested  that  women  have  shone  in 
some  of  the  fields  of  great  human  endeavor.  They 
have  so  shone,  but  never  has  their  light  dazzled 
the  world.  The  other  day  in  Cambridge  a  distin- 


io8  A  Doctor's  Table  Talk 

guished  woman  astronomer  died.  She  was  famous 
for  minute  and  painstaking  studies  of  statistics, 
for  interpreting  stellar  photographs,  for  compiling 
data.  No  woman  has  founded  a  great  scientific 
system;  the  women  have  produced  no  Confucius, 
no  Galileo,  no  Newton.  The  strong,  sane,  penetrat- 
ing minds  among  them  range  another  field.  They 
are  close,  exact,  microscopic,  while  the  minds  of  the 
great  men  among  us  are  generous,  wide-ranging, 
telescopic,  if  one  may  phrase  it  so. 

"The  progress  of  mankind  and  their  happiness 
are  dependent  on  other  things,  however,  than  the 
great  achievements  I  have  named;  and  towards  that 
progress  women's  contributions  have  been  great,  if 
not  priceless.  The  bearing  and  rearing  of  the  human 
race  alone  would  place  woman  on  a  plane  higher 
than  that  occupied  by  mere  physical  man,  but  she 
has  done  more;  she  has  concentrated,  coordinated, 
and  made  permanent  and  coherent  the  civilization 
carved  out  by  man.  Without  this  work  of  woman, 
civilization  could  not  persist.  Wherever  and  when- 
ever woman  has  been  debased  or  abolished,  civil- 
ization has  withered  and  failed.  Such  is  the  teach- 
ing of  history.  Among  those  peoples  and  races 
where  woman  has  been  down-trodden,  progress  has 


Dr.  Primrose  on  Women  IC9 

languished;  and  chaos,  ignorance,  cruelty,  and  vice 
have  usurped  the  place  of  generous  enlightenment. 
The  story  of  Oriental  civilization  shows  this;  for 
with  those  Eastern  peoples  the  debasing  of  woman 
and  the  development  of  a  semi-barbarism  went 
hand  in  hand.  Among  the  ancients,  —  the  Greeks 
and  the  Romans,  —  the  fall  of  woman  and  the 
degeneration  of  empires  coincided.  The  brutal  wars 
of  mediaeval  and  modern  times,  while  they  destroyed 
the  influence  of  woman,  coincidently  halted  and 
put  back  progress.  In  our  own  country  no  per- 
manent establishments  were  made  by  explorers, 
colonists,  or  pioneers  until  woman  came  to  join  in 
the  work. 

"This  surprising  and  convincing  influence  of 
woman  has  been  subtle  but  effective.  About  women 
have  gathered  the  fundamental  elements  which 
make  for  permanence  and  advance,  —  the  concep- 
tion and  establishment  of  the  roof-tree  and  the 
home;  of  the  family,  the  tribe,  the  village  settle- 
ment, the  state,  and  the  nation.  For  her  and  for 
the  children  men  have  fought  and  died  that  she  and 
her  ideals  might  endure.  Her  influence  has  con- 
firmed and  cemented  every  forward  step.  For  her 
have  been  wrought  the  arts  of  peace,  through  the 


no  A  Doctor's  Table  Talk 

establishment  of  which  the  great  accomplishments 
of  mankind  have  been  made  possible.  In  all  these 
matters  woman  has  been  no  idle  observer,  no  pas- 
senger, as  we  say.  She  has  taken  an  active,  strenu- 
ous, and  unceasing  part.  She  has  advised,  admon- 
ished, and  approved.  She  has  bestowed  rewards; 
she  has  stood  for  comfort,  sanity,  and  happiness. 
Without  her  cooperation,  man  in  his  forward  strug- 
gle would  have  come  to  naught  and  have  ceased. 
With  her  cooperation,  we  see  supplemented  and 
made  effective  the  toil  of  man.  Through  the  ages 
men  and  women  have  stood  together,  shoulder  to 
shoulder,  and  have  created  the  good  world  in 
which  we  live. 

"  So  it  comes  about  that  if  a  sound  development 
of  the  historic  sense  and  a  broad  outlook  upon  the 
world  teach  us  anything  of  the  relations  of  men  and 
women,  and  of  the  capacities  and  achievements  of 
both,  it  is  that  the  sexes  supplement  and  support 
each  other.  Neither  can  successfully  break  into  or 
take  over  the  other's  work.  Physiology  teaches 
this;  psychology  confirms  it.  Man  at  his  best,  in  his 
greatest  expression,  is  prophetic,  judicial,  compel- 
ling, creative.  Woman  is  faithful,  patient,  enduring, 
supporting,  generous,  conservative.   Through  jus- 


Dr.  Primrose  on  Women  1 1 1 

tice  and  sanity  man  has  constructed  democracy. 
You  cannot  democratize  woman.  Man  builds; 
woman  conserves;  and  an  unhalting  progress  in 
social  uplift  results." 

We  all  applauded. 

"That's  a  good  piece,  Primrose,"  said  Ely;  "you 
ought  to  publish  it." 

"I've  tried  to  publish  it,  but  the  editors  won't 
take  it." 

"Why.?" 

"They're  afraid  of  it,  I  think.  I  sent  it  to  *The 
Antarctic  Monthly.'  The  editor  flattered  me,  but 
said  the  public  were  tired  of  the  subject.  Then  I 
sent  it  to  the  weekly  *  Forecast'  in  New  York.  The 
editor  returned  it  with  thanks.  Two  weeks  later 
our  most  distinguished  fellow  citizen  published  in 
that  journal  an  article  on  the  same  subject;  but 
it  was  a  mild  utterance.  I  observed,  too,  that  he 
did  not  altogether  agree  with  the  veteran  editor-in- 
chief." 

"You  know,  of  course,  that  that  article  is  not 
going  to  add  to  your  popularity." 

"I  don't  know;  for  I  don't  yet  know  which  is  the 
popular  side." 


112  A  Doctor'* s  Table  Talk 

"You  will  find,  I  think,  that  the  women  divide 
themselves  broadly  into  three  social  groups  or 
classes,  —  just  as  civilized  mankind  has  always 
and  inevitably  divided  itself  into  three  classes,  — 
the  *  upper,'  the  *  middle,'  and  the  *  lower.'  It's 
an  artificial  thing,  —  a  question  of  money-getting 
capacity  on  some  one's  part,  and  the  ability  to 
keep  it.  The  upper  class  among  women  have  come 
to  see  that  the  suffrage  has  little  in  it  for  them,  so 
long  as  it  is  not  limited  to  property-holders;  the 
lower  class  are  too  serious  and  too  busy  with  the 
personal  problems  of  daily  life  to  think  or  care  any- 
thing about  the  suffrage.  The  result  is  that  the 
question  is  left  mainly  in  the  hands  of  the  great 
seething  middle  class,  with  women  especially  more 
or  less  unattached  or  unemployed.  These  vigorous 
and  kindly  souls  are  bestirring  themselves,  not  only 
for  themselves,  but  for  their  less  fortunate  sisters. 
That  great  middle  class  will  not  like  your  saying 
that  the  women  have  done  none  of  the  big  construc- 
tive things.  They'll  point  to  Joan  of  Arc,  Queen 
Elizabeth,  George  Eliot,  and  Queen  Victoria.  I  'm 
glad  I  have  not  to  settle  the  question  you've  at- 
tacked. My  patients  and  consultants  give  me  plenty 
to  do." 


Dr.  Primrose  on  Women  113 

"But  that's  absurd.  Those  four  women  con- 
structed nothing." 

"Of  course  not." 

"Then  why— .?" 

"Exactly;  why."*  That's  the  one  trouble  with  the 
whole  situation.  I  advise  you  to  let  it  alone.  It's 
probably  not  the  great  issue  that  some  people  think 
it.  It's  a  means,  not  an  end.  The  end  we  should 
have  in  view  is  good  government.  Vox  populi,  vox 
Dei,  may  be  true,  —  I  don't  know.  It 's  the  best 
thing  we  have  found  yet;  generally,  but  not  al- 
ways." 

Primrose  sat  silent  for  a  few  minutes.  Then  he 
said:  "If  this  is  a  great  movement  it  is  the  first 
great  movement,  right  or  wrong,  which  has  had  no 
great  leaders.  Think  of  some  of  the  great  reform 
movements  of  modern  times:  the  Reformation 
with  its  Luther,  its  Wycliffe,  and  its  William  of 
Orange;  the  great  Civil  War  of  England,  with 
Hampden,  Pym,  Cromwell;  the  American  Revolu- 
tion and  Constitution  building,  with  their  Wash- 
ington and  Hamilton;  the  French  Revolution,  with 
its  Voltaire,  Rousseau,  Mirabeau,  and  the  rest;  the 
Reform  of  the  Suffrage  in  England  eighty  years 
ago,  and  the  strong  men  who  debated  it;  to  say 


114  A  Doctor's  Table  Talk 

nothing  of  our  Slavery  problem  and  the  Civil  War, 
with  the  great  men,  and  women,  too,  on  both  sides. 
Those  were  truly  mighty  questions  that  produced 
their  giants,  but  I  don't  see  any  one  above  five 
feet  two  in  the  present  scramble." 

"  I  dare  say.  But  keep  cool.  And  first  let  us  see 
the  result  of  your  New  Hampshire  referendum. 

"'For  forms  of  government  let  fools  contest; 
Whate'er  is  best  administered  is  best: 
For  modes  of  faith  let  graceless  zealots  fight; 
His  can't  be  wrong  whose  life  is  in  the  right.' " 


CHAPTER  VI 

The  Doctor  is  a  Patient 

My  friend  Primrose  has  been  ill.  The  busy  doc- 
tor has  for  months  been  turned  in  upon  himself. 
He  has  forgotten  the  Woman  Suffrage  trouble 
as  a  trouble;  and  he  has  taken  to  analyzing  life 
through  his  own  glasses.  He  looks  back  in  these 
days  to  his  long  neglected  "Religio  Medici";  and 
he  talks  about  the  mysteries  of  the  unknowable  as 
though,  indeed,  they  were  very  present  with  him. 
He  quotes  with  gusto  Sir  Thomas  Browne:  "The 
Devil,  that  did  but  buffet  St.  Paul,  plays,  methinks, 
at  sharps  with  me.  Let  me  be  nothing,  if  within  the 
compass  of  myself  I  do  not  find  the  battail  of  Le- 
panto.  Passion  against  Reason,  Reason  against 
Faith,  Faith  against  the  Devil,  and  my  Conscience 
against  all.  ...  As  Reason  is  a  Rebel  unto  Faith, 
so  Passion  unto  Reason:  as  the  propositions  of 
Faith  seem  absurd  unto  Reason,  so  the  Theorems  of 
Reason  unto  Passion,  and  both  unto  Reason.  Yet 
a  moderate  and  peaceable  discretion  may  so  state 
and  order  the  matter,  that  they  may  be  all  Kings, 


Ii6  A  Doctor^ s  Table  Talk 

and  yet  make  but  one  Monarchy.  .  .  ."  And  so  he 
concludes  serenely  in  cheerful  optimism. 

He  has  taken  to  much  letter-writing  and  he 
copies  from  voluminous  journals:  — 

My  dear  Scriba,  —  You  will  wonder  that  I  have 
been  so  long  silent,  but  indeed  my  Pride  hath  had 
its  fall;  though  I  trust  that 

"my  way  of  life 
Is  (not  yet)  fallen  into  the  sear,  the  yellow  leaf." 

My  doctor  friends,  with  cruel  kindness,  have  turned 
upon  me;  three  months  ago  they  put  me  to  bed,  and 
in  bed  I  remain.  Of  them  all,  Ely  is  the  only  one  of 
humanity  and  intelligence.  It  seems  that  I  played 
the  mischief  with  that  clock  inside  my  chest,  and 
so  I  have  at  last  fallen  upon  evil  days.  When  I  'm 
ill,  though,  I  think  of  our  dear  old  chum  Optimus 
in  Ohio.  I  know  you  loved  him.  For  me  he  was  the 
greatest  physician  in  the  land.  Read  this :  it  is  the 
letter  he  sent  me  when  he  heard  that  I  was  laid  low 
three  years  since.  Perhaps  it  may  help  you  or  your 
patients  some  day.  It  gives  me  a  strange  thrill  to 
think  that  he  himself  has  gone  before,  leaving  us  to 
keep  up  the  fight:  "Dear  Jack, —  George  has  just 
been  down  to  see  me,  very  unhappy  over  your 


The  Doctor  is  a  Patient  117 

letter.  I  have  been  showing  him  what  James  Mac- 
kenzie says  about  prognosis  in  his  wonderful  new 
book  on  Diseases  of  the  Heart,  and  have  sent  him 
off  in  a  much  more  cheerful  frame  of  mind;  and  I 
want  to  send  on  to  you  some  of  Mackenzie's  optim- 
ism. To  begin  with,  get  somebody  to  read  to  you, 
on  page  257  of  his  book,  his  history  of  the  mechani- 
cal engineer  who  twenty-six  years  ago,  at  thirty- 
two,  had  rheumatism,  and  was  left  with  a  mitral 
lesion;  fourteen  years  later  he  lay  for  weeks  uncon- 
scious with  dropsy;  from  this  he  recovered  with  all 
kinds  of  heart  murmurs  and  irregularities;  but  none 
the  less,  since,  and  up  to  date,  he  has  been  doing 
the  laborious  work  of  his  profession  as  well  as  any- 
body. We  doctor-folk,  with  our  stethoscopes,  are 
apt  to  take  too  grave  a  view  of  the  extent  of  restora- 
tion possible  in  recent  heart  lesions.  The  general 
practitioner  who  follows  his  people  through  their 
illnesses  and  long  afterwards,  or  who,  like  myself, 
has  inherited  patients  from  father  and  grandfather, 
knows  how  long  a  life  and  how  active  a  one  a  man 
may  lead  who  has  seemed  hopelessly  invalided  when 
his  rheumatic  heart  lesion  was  new.  The  long  stay 
in  bed  at  the  first,  with  massage  and  resistive  move- 
ments by  and  by,  to  strengthen  the  skeletal  and 


Ii8  A  Doctor's  Table  Talk 

heart  muscles,  are  therapeutic  tricks  our  fathers, 
too,  did  not  know;  and  unquestionably  the  rest  less- 
ens the  puckering  and  shrinking  of  a  valve  scar. 
I  should  like  to  talk  to  you  about  patients.  Two 
years  ago  a  man  of  about  your  age  had  a  rheumatic 
fever,  and  developed  both  mitral  and  aortic  lesions. 
I  shook  my  head  over  him,  and  told  his  friends 
what  your  doctors  are  saying  to  you.  He  stayed  in 
bed  three  months,  and  went  slow  for  a  year;  but 
now  he  is  in  the  hurly-burly  again,  and  likely  to 
live  a  life  of  activity  for  years  so  far  as  I  can  see.  .  .  . 
I  hope  Dr.  Samson  has  been  well  enough  to  see  you. 
He  is  the  chap  I  should  like  to  have  talk  to  me,  if  I 
lay  on  my  back  with  a  heart  lesion,  and  wanted  to 
know  what  the  future  held.  But  inevitably  the 
doctor's  stethoscope  scares  him,  and  misleads  him 
in  estimating  the  significance  of  recent  lesions.  .  .  . 
And  then,  if  you  are  left  like  a  cup  with  a  crack  in 
it,  that  is  the  one  that  outlasts  the  rest  of  the  set, 
if  it  is  kept  out  of  boiling  water.  Did  you  ever  read 
Weir  Mitchell's  charming  essay  on  convalescence.? 
You  have  resources  enough  to  make  a  'pleasant 
land  of  counterpane'  for  yourself,  I  know.  Now 
I'm  off  for  Bermuda  with  the  boy.  Good-bye.  As 
ever,  yours,  E.  F.  O." 


The  Doctor  is  a  Patient  119 

"Omnem  crede  diem  tibi  diluxisse  supremum  "  was 
truly  part  of  Optimus's  creed;  but  I  cannot  help 
feeling  that  that  brave  fellow's  death  was  an 
offense  to  medicine.  And  does  it  not  give  one  a 
catch  in  the  throat  to  read  those  fine,  ringing,  In- 
spiring words,  posthumous,  as  it  were,  from  a  man 
who  led  the  life  for  all  there  is  in  it.  That  was 
a  physician  of  the  sort  for  which  the  world  will 
always  cry,  —  of  a  species  almost  extinct.  Useful 
and  self-sacrificing  as  are  many  of  our  laboratory 
men,  I  am  growing  a  little  tired  of  hearing  them 
proclaimed  the  heroes  of  medicine.  What  in  civil 
life  could  be  more  heroic  than  the  career  of  Opti- 
mus  ?  With  a  mind  of  the  finest,  and  the  whitest  of 
souls;  generous  as  a  woman,  gentle-spirited  as  a 
child;  worldly-wise  from  long  training,  but  great- 
hearted, charitable,  and  infinitely  kind,  —  his  was 
a  character  of  which  it  is  an  Inspiration  to  think. 
He  was  splendidly  equipped  for  his  work.  His 
broad  interests  and  wide-ranging  thought  inter- 
preted the  needs  of  the  time.  He  was  brilliantly 
qualified  to  practice  either  as  surgeon  or  physician, 
for  such  was  his  training.  Finding  to  hand,  how- 
ever, a  surgical  colleague  of  sympathetic  mind  and 
progressive  views,  Optimus  abandoned  surgery, 


I20  A  Doctor's  Table  Talk 

and  for  twenty  years  devoted  himself  constantly, 
untiringly,  generously,  superbly  to  that  humble 
calling  —  the  practice  of  general  medicine.  Mod- 
est, retiring,  silent,  he  did  his  own  work  and  no 
other.  In  a  measure  he  had  his  reward.  In  all 
things  medical,  and  in  much  else,  the  great  com- 
munity in  which  he  lived  became  his  devoted  sub- 
jects. In  any  field  of  service  he  would  have  shone. 
He  might  even  have  emulated  yon  capering  Smilax, 
of  whom  you  tell.  He  might  well  have  been  a 
national  figure;  but  he  was  content  with  a  career 
which  the  absurd  fiction  of  to-day  regards  as  hum- 
ble and  commonplace.  He  was  simply  useful.  His 
was  a  life  of  service  to  thousands  of  his  fellow  men. 
There  is  a  saying  that  every  life,  however  com- 
monplace and  humble,  may  be  of  supreme  interest, 
and  carry  its  great  lesson,  if  that  lesson  be  but 
properly  told.  Here  was  a  life  abundantly  worth 
the  telling. 

"He  had  kept 
The  whiteness  of  his  soul,  and  thus  men  o'er  him  wept." 

This  letter  is  degenerating  into  an  epistle,  but 
I  find  there  is  a  lot  I  want  to  say.  Perhaps  it  is  the 
familiar  sick  man's  garrulity;  and  yet,  like  the 
patient  "coming  out  of  ether,"  I  want  to  tell  all 


The  Doctor  is  a  Patient  121 

about  it,  for  I  am  sure  that  no  one  else  has  had  such 
a  unique  experience.  In  the  first  place,  I  am  at  last 
convinced  in  my  own  person  that  one  may  drift  into 
alarming  and  serious  illness  without  special  dis- 
comfort. We  doctors  all  know  how  there  is  rarely 
any  such  thing  as  the  traditional  "death-agony," 
because  most  people  become  unconscious  long  be- 
fore they  die;  but  we  sometimes  forget  that  other 
fact  about  serious  Illness.  Of  course  sickness  is  as 
natural  a  process  as  are  birth,  death,  and  decay; 
and  I  suppose  some  day,  when  Almoth  Wright  and 
the  others  have  worked  out  their  problem  beyond 
peradventure,  showing  the  organism  that  causes  the 
given  patient's  disease,  and  by  the  opsonic  index, 
his  exact  powers  of  resistance,  that  then  we  can 
increase  his  resisting  powers  at  will,  and  play  up 
and  down  the  scale  with  every  feeling  of  assur- 
ance. 

My  friend,  I  was  sick;  not  merely  "ill,"  as  our 
English  friends  would  say —  for  they  do  corrupt  and 
turn  to  contemptible  uses  the  good  old  Anglo-Saxon 
speech;  I  lay  on  a  "sick-bed,"  in  a  "sick-room"; 
I  was  truly  on  "  sick-leave,"  and  the  "sick-list,"  and 
I  experienced  many  new  things.  Was  it  not  our  old 
James  Jackson  who  wrote  that  no  physician  could 


122  A  Doctor* s  Table  Talk 

regard  himself  as  thoroughly  competent  to  practice 
medicine  until  he  had  experienced  a  serious  sickness 
in  his  own  person  ?  We  are  wont  to  say  that  a  period 
of  severe  sickness  seems  a  nebulous  period  after- 
wards. Perhaps  so.  But  this  time  I  declared  to  my- 
self that  no  detail  should  escape  me  or  be  forgotten, 
and  I  think  I  succeeded  in  my  resolve.  After  six 
months  of  unwonted  feebleness,  with  increasing 
shortness  of  breath,  rapidity  of  pulse,  and  failing 
mental  vigor,  I  finally  consulted  Ely,  who  told  me 
that  I  had  tachycardia,  which  I  knew;  with  a 
dilated  heart,  which  I  had  suspected;  and  sent  me 
to  bed  under  the  immediate  care  of  one  of  my  kind 
neighbors  here.  Since  that  time  —  three  months 
ago  —  I  've  lain  in  bed  with  reasonable  cheerful- 
ness, and  have  observed  life.  I've  made  some 
study  of  sick-room  attendants,  especially  of  doc- 
tors and  their  ways.  I've  been  under  the  care  of, 
or  been  visited  by,  eight  or  ten  of  the  faculty,  and 
on  the  whole  I  've  concluded  that  they  are  a  fine  set 
of  fellows.  There  is  a  tradition  that  doctors  make 
bad  patients.  I  think  I've  disabused  my  friends  of 
that  notion.  I  am  sure  I  have  been  a  fairly  good 
patient,  and  I  am  not  sure  but  what  that  is  true 
of  most  men.   You  remember  that  when  we  were 


The  Doctor  is  a  Patient  123 

hospital  house-officers  the  experienced  nurses  used 
to  say  they  would  rather  take  care  of  a  ward  full 
of  men  than  a  ward  full  of  women;  because,  in  the 
case  of  acute  illness,  men  are  so  much  more  docile 
—  less  critical,  less  peevish,  less  fault-finding.  Men 
don't  know  much  about  illness.  Nowadays  they 
have  little  experience  in  the  nursery.  That  does 
not  seem  to  be  a  part  of  their  job.  The  atmosphere 
of  the  sick-room  is  woman's  own.  Why  is  it,  then, 
that  women  are  not  the  great  doctors,  the  great 
clinicians?  I  sometimes  ask  myself.  Perhaps  because 
they  have  been  at  the  business  too  short  a  time  to 
have  gained  the  proper  assurance.  But  it  seems  as 
though  there  must  be  some  inherent  reason ;  other- 
wise, during  the  seventy  years  or  more  that  women 
have  been  going  into  medicine,  they  would  have 
produced  at  least  one  great  physician.  They  will 
do  it  yet,  I  feel  sure  they  will  do  it  yet.  I  doubt  if 
they  have  had  half  a  chance  until  now.  Johns 
Hopkins  is  educating  them  alongside  of  the  men. 
Let  us  await  developments  there. 

For  myself,  I  presume  I  have  been  peevish 
enough,  and  a  grief  to  my  friends.  Though  I  seem 
to  have  the  whole  experience  in  memory,  still  there 
are  one  or  two  knock-out  features;  especially  a 


124  ^  Doctor* s  Table  Talk 

sense  of  overwhelming  unreality,  as  though  one 
were  another  person.  I  suppose  the  simple  expla- 
nation of  that  is  the  variation  in  the  intracranial 
blood  pressure  —  an  entirely  natural  phenomenon, 
accentuated  at  times  by  hyperactivity  of  the  heat 
centre;  for,  mark  you,  rheumatism  and  fever  have 
added  variety  to  my  lot.  The  other  most  pro- 
nounced and  interesting  feature  of  Illness,  I  find 
to  be  the  astonishing  feebleness.  I  fancy  that 
explains  the  unaccountable  alarm  which  many 
men,  as  contrasted  with  women,  display  in  sick- 
ness. With  men  in  sickness  the  variation  from  nor- 
mal health  is  much  the  greater.  A  majority  of 
women  are  accustomed  to  a  certain  amount  of  ill- 
health,  or  at  least  to  recurring  periods  of  depression, 
lassitude,  and  feebleness.  Prostrating  disease  for 
them  Is  no  such  stunning  surprise  as  for  men.  So 
the  men  for  a  time  protest  and  complain  in  most 
unhandsome  fashion.  I  don't  think  that  I  showed 
any  improper  alarm,  but  I  admit  that  for  a  time 
I  was  undone  mentally  as  well  as  physically;  and 
that,  to  my  shame  and  disgust,  I  found  myself 
taking  a  jabbering  interest  in  my  own  symptoms, 
and  hanging  on  to  my  doctor  like  a  sailor  to  an 
upset  dory. 


The  Doctor  is  a  Patient  125 

Perhaps  the  most  distressing,  even  humiliating 
part  of  the  whole  experience  for  me  was  the  sick- 
bed toilet.  That,  I  suppose,  is  a  matter  of  individual 
temperament;  but  for  me,  to  have  a  young  woman 
eternally  hanging  about,  bossing  me,  entering 
without  knocking,  violating  my  privacy,  brushing 
my  teeth,  washing  my  face,  and  rubbing  my  legs 
was  intolerable.  And  then,  her  reading  aloud! 
She  never  tried  it  but  once.  I  am  sure  that  the 
modern  trained  nurse  is  a  great  comfort  to  the 
doctor ;  and  I  know  that  my  specimen  is  a  good 
and  superior  girl,  for  she's  a  neighbor's  daughter, 
and  used  to  play  in  my  back  garden;  but  upon  my 
word,  it  seems  at  times  as  though  the  Devil  was  in 
her.  She  hangs  around  during  the  doctor's  visit, 
and  "  makes  remarks."  She  bustles  from  the  room 
with  him,  and  holds  him  in  long  whispered  consul- 
tation outside  my  half-open  door.  She  returns 
with  an  air  of  superior  knowledge;  and  she  actually 
has  the  effrontery  to  tell  me  not  to  be  nervous. 
Worst  of  all,  she  munches  apples  in  my  presence, 
and  she  sleeps  in  my  room  and  snores.  Yes;  I  sup- 
pose I  am  nervous,  as  she  tells  me  to  my  face. 

Is  it  not  a  dreary  and  sordid  talcf*  And  yet 
there   are   compensations.    When   I  was   at   my 


126  A  Doctor's  Table  Talk 

worst,  they  thought  it  would  be  a  good  thing  to 
have  a  doctor  in  the  house  for  a  few  days;  so  Ely 
sent  up  young  Flaxman.  You  remember,  the 
clever  chap  in  the  disreputable  suburban  office, 
whom  you  advised  to  find  proper  quarters,  become 
a  professional,  and  marry  a  wife.  He's  not  yet 
found  the  wife,  as  you  know,  but  in  other  respects 
he  has  found  his  feet  and  is  trig,  smiling,  and  hu- 
man. He  did  me  a  power  of  good,  and  I  am  not  sure 
but  what  he  "pulled  me  through,"  as  they  say. 

I  told  him  that  I  had  heard  of  him,  and  asked 
if  he  had  moved  his  quarters.  Yes:  it  seems  he 
moved  into  the  next  block  a  week  after  your  visit. 
His  cross  landlady  would  hardly  let  him  go  without 
searching  his  trunk,  while  the  "  collarless  drab  "  put 
on  some  forlorn  neck-gear,  and  burst  into  tears  as 
she  packed  his  shirts.  He  now  lives  in  a  smart 
little  apartment  of  his  own,  drives  a  motor,  and 
tells  me  that  his  practice  trebled  last  year.  Mrs. 
Primrose  and  the  children  felt  that  they  could  not 
let  him  go,  and  I  fancy  he  took  all  their  hearts  with 
him.  Apropos,  what  father  knows  his  own  daugh- 
ter? 

Now,  my  friend,  I  am  convalescent;  that  is  the 
wonderful  fact  I  have  to  tell;  and  you  must  come 


The  Doctor  is  a  Patient  1 27 

to  see  me.  The  winter  is  over;  spring  Is  at  hand; 
by  six  of  the  clock  the  sun  now  crowns  the  peak; 
the  sap  runs  eager  in  the  trees;  buds  sprout  from 
willow  boughs  along  the  brook;  a  soft  and  tender 
green  enshrouds  the  hill,  the  streams  rush  full,  and 
crowd  the  jealous  bank. 

"And  this  reviving  Herb,  whose  tender  Green 
Fledges  the  River-Lip  on  which  we  lean  — 
Ah,  lean  upon  it  lightly!  for  who  knows 
From  what  once  lovely  Lip  it  springs  unseen!" 

There's  no  one  like  dear  old  Fitzgerald  to 
translate  some  of  our  thoughts.  And  how  wonder- 
ful Is  this  spring-time  of  returning  health!  Your 
heart  beats  full  and  strong;  you  feel  no  anxious 
flutter  In  the  chest;  your  breathing's  like  a  child's 
—  regular,  deep.  You  sleep  as  boyhood  sleeps  — 
hour  after  hour.  Haply  you  eat  —  the  gods  pro- 
vide the  food ;  Ceres  attends ;  you  shake  off  vulgar 
cares;  the  merry,  merry  days  of  youth  seem  for  the 
moment  gently  to  return.  You  hold  a  cherished 
hand;  some  soft  emotion  thrills  your  moistened 
eyes;  old  friends,  old  books,  old  thoughts  engross 
your  heart;  you  sigh  and  smile;  again  the  world  is 
yours.  Such  is  the  measure  of  my  great  content, 
and  you  must  share  it.  We've  much  to  say.  I've 


128  A  Doctor's  Table  Talk 

read  some  books  while  you've  been  reading 
men.  Bring  Ely,  if  you  can;  the  time  for  talk  has 
come. 

That  very  next  Saturday  afternoon  Ely  and  I 
reached  Poquonnock  Village  for  a  week-end  with 
our  old  friend  and  his  family.  We  left  the  stage  — 
ten  miles  from  the  railway  —  at  the  foot  of  his  ram- 
bling street,  and  strolled  to  his  house.  The  joy  of 
the  land  was  all  that  Primrose  said.  The  clear 
upland  air,  the  soft  wind  with  a  suggestion  of  sum- 
mer in  its  caress,  the  smell  of  new-turned  soil,  the 
delicious  warmth  of  the  kind  embracing  sun 
seemed  indeed  to  restore  our  youth.  Ely,  emanci- 
pated, frisked  like  a  puppy.  He  took  off  his  hat, 
and  stretched  and  shouted.  He  cast  from  him  his 
coat  to  my  devoted  back.  He  capered  in  the  middle 
of  the  road,  to  the  dismay  of  a  patient  ox  team 
approaching;  and  his  happiness  was  complete 
when  he  discovered  a  stately  and  solemn  proces- 
sion of  geese  debouching  in  single  file  upon  our 
path.  Immediately  he  named  them,  —  Obadiah, 
Amos,  Barnum,  Savonarola,  Mr.  Carnegie,  and 
Mary  Baker  Eddy.  He  assured  me  that  Mr.  Car- 
negie was  the  only  one  In  the  flock  with  a  sense 


The  Doctor  is  a  Patient  129 

of  humor,  and  he  proceeded  to  prove  his  point 
by  bombarding  them  gently  with  a  shower  of 
pebbles. 

The  gabble  of  the  geese  and  the  shouts  of  Ely 
were  at  their  height  when  a  peal  of  laughter  and  a 
call  upon  our  names  came  to  us  from  a  buggy 
which  trotted  past.  A  girl  waved  her  whip  at  us 
and  a  young  man  raised  his  hat. 

"Upon  my  word,"  said  Ely,  flushed  and  sedate, 
"that's  my  friend  Marion  Primrose;  and  the  man 
is  Flaxman,  the  rogue.  Observe  me,  Scriba,  —  for 
I  claim  to  be  as  knowing  as  a  woman  in  these  mat- 
ters, —  there's  a  match.  From  Flaxman  now  let  me 
depart  in  peace.  His  destiny  and  your  prescription 
are  met.  His  future's  safe."  The  buggy  was  dis- 
appearing around  the  curve.  The  girl's  big  hat, 
well-poised  whip,  and  upright  figure  seemed  set  at 
"attention";  while  beside  her  the  young  man's 
head  was  bent,  and  his  right  arm  thrown  over  the 
back  of  the  seat  in  privileged  lover  fashion.  "And 
a  good  thing,  too;  a  good  thing,"  said  the  astute 
Ely,  as  he  wagged  his  foolish  bachelor  head. 

Almost  in  silence  we  strolled  on  up  the  hill  after 
this,  though  an  occasional  muttering  at  my  side 
assured  me  that  Flaxman  was  a  young  villain,  that 


I30  A  Doctor's  Table  Talk 

Marion  Primrose  was  a  sweet  thing,  and  that  that 
arch  plotter  Ely  was  content. 

As  we  turned  in  at  the  Primrose  gate,  a  little 
whirlwind  came  down  behind  us,  and  a  manly- 
voice  chanted  the  sturdy  lines  of  a  great  American 
epic:  — 

"There  was  ease  in  Casey's  manner  as  he  stepped  into  his 

place, 
There  was  pride  in  Casey's  bearing,  and  a  smile  lit  Casey's 

face; 
And  when,  responding  to  the  cheers,  he  lightly  doffed  his  hat, 
No  stranger  in  the  crowd  could  doubt  'twas  Casey  at  the 

bat." 

But  even  an  engagement  in  the  family  could  not 
long  keep  our  old  friend  Primrose  from  his  favorite 
topics.  Of  course  he  was  glad  to  see  us,  and  his 
eyes  glistened  with  kindly  emotion  and  a  loyal  wel- 
come as  he  held  our  hands.  We  learned  that  Flax- 
man  had  been  regarded  for  some  weeks  as  one  of 
themselves;  that  the  wedding  would  take  place  in 
June;  and  that  the  young  couple  would  live  in  the 
Poquonnock  neighborhood.  An  important  endowed 
hospital  had  been  opened  in  the  near-by  town  of 
Asphodel,  with  Primrose  and  Flaxman  respect- 
ively as  physician  and  surgeon-in-chief. 


The  Doctor  is  a  Patient  131 

Primrose  is  a  person  of  unappeasable  curiosity. 
It  seems  that  there  has  been  recently  a  serious 
strike  among  the  mill  operatives  in  one  of  our 
New  England  towns.  Primrose  thinks  that  he  is 
half  a  Socialist,  as  is  Flaxman  altogether;  so  the 
younger  man  was  straightway  packed  off  to  the 
mills  to  study  the  situation.  We  all  sat  round  the 
great  open  fire  in  the  library  that  evening  discuss- 
ing the  affair.  Flaxman,  with  a  good  deal  of  earnest 
excitement,  told  his  story,  and  Primrose  expressed 
general  views.  It  was  all  trite  enough,  I  dare  say, 
and  of  small  value  to  experts ;  but  for  the  audi- 
ence of  uninformed  city  doctors  it  was  novel  and 
thrilling. 

Flaxman,  while  investigating,  had  met  Weyl, 
the  well-known  correspondent,  to  whose  superior 
knowledge  he  owed  much.  As  the  correspondent 
wrote  later:  "The  strike  came  suddenly.  The 
Legislature  had  passed  a  law  reducing  the  hours 
of  labor  from  fifty-six  to  fifty-four,  and  the  mill- 
owners,  without  warning  to  their  employees,  re- 
duced wages  in  a  like  proportion.  It  was  a  ruthless, 
immoral,  ill-advised  proceeding.  It  was  ruthless, 
because  wages  already  were  indecently  low.  .  .  . 
They  are  far  lower,  here  as  elsewhere,  than  the 


132  A  Doctor's  Table  Talk 

cost  of  living  and  the  demands  of  our  American 
civilization  imperatively  require.  It  was  immoral, 
because  the  method  of  reduction  was  that  of  a  de- 
spotic master  deciding,  according  to  his  sole  will, 
the  fate  of  his  subjects.  It  was  ill-advised,  because 
it  revealed  to  an  already  irritated  American  public 
the  other  side  of  Schedule  K.  It  showed  that  the 
woolen  manufacturers  were  obtaining  a  high  pro- 
tective tariff  under  the  false  pretense  of  benefiting 
American  labor.  I  have  rarely  seen  in  any  Ameri- 
can city  so  many  shivering  men,  without  overcoats, 
as  I  have  seen  in  this  cloth-producing  town." 

With  such  views  Flaxman  was  in  sympathy. 
He  had  found  a  community  of  many  nationalities, 
and  little  English  spoken;  but  with  the  exception 
of  a  few  hot-heads  the  people  —  German,  French, 
Flemish,  Italian,  Syrian,  and  the  like  —  were 
peaceable  and  kindly,  debating  the  situation  witS 
anxiety,  but  with  entire  good  temper.  A  large 
body  of  militia  had  been  called  out  to  keep  order, 
but  they  found  little  to  do.  Yet  here  is  an  eco- 
nomic situation,  as  Flaxman  declares,  which  has 
advanced  almost  beyond  the  limits  of  human 
endurance;  and  again  he  quotes  Weyl:  "To-day, 
to-morrow,  and  year  after  year  in  America  the 


The  Doctor  is  a  Patient  133 

question  raised  at  the  conference  between  legisla- 
tors and  strikers  will  rise  up  against  us,  'What  can 
the  State  do?  What  can  we  do  to  make  the  wrong 
right  for  the  people  of  our  mills  and  factories?'" 

This  sort  of  discussion  could  not  have  been  a 
good  thing  for  Dr.  Primrose  in  his  feeble  state. 
He  restrained  himself,  as  best  he  could,  however; 
but  at  last  with  a  flash,  and  his  old-time  quiver  he 
broke  in :  — 

"Public  men  and  newspapers,  from  Mr.  Roose- 
velt down  to  the  editor  of  'Barker's  Weekly,'  have 
been  doing  a  powerful  lot  of  talking  of  late  years 
about  Socialism  and  its  dreadful  dangers.  What  do 
they  mean?  I'd  like  to  know.  Or  what  do  they 
think  they  mean?  They  don't  define  Socialism. 
No  one  does.  Socialism  is  not  Anarchy,  as  most  of 
them  seem  to  think.  Our  most  respectable  people, 
whenever  they  get  a  little  frightened,  or  dislike 
some  political  movement  of  their  opponents,  go 
Into  hysterics,  and  tell  us  to  look  out  for  Socialism. 
Our  ordinary  politicians  are  the  most  irritating. 
The  average  Representative  in  Congress  is  a  gaby, 
with  facility  for  stringing  words  together  In  pom- 
pous and  regular  cadence.  Socialism  Is  his  word 
of  words.   He's  uneducated,  of  course.  He  has  no 


134  -^  Doctor's  Table  Talk 

vision.  He  has  no  expression  of  patriotism  in  the 
wider  sense;  though  the  pathetic  fellow  in  his  soul 
really  thinks  he  has  patriotism  itself.  Fortunately, 
from  time  to  time  he  has  wit  enough  to  choose 
superior  leaders,  otherwise  would  representative 
government  go  to  wreck,  in  spite  of  harking  back 
to  such  panaceas  as  rejerendums,  initiatives^  and 
the  like. 

"Pd  like  to  know  something  more  about  that 
Socialism  bogy.  Many  of  us  would.  I  observe  that 
several  millions  of  our  fellow  creatures  call  them- 
selves Socialists,  and  that  a  great  many  of  them 
are  keenly  intelligent  persons.  I  suppose  that  the 
Germans  of  to-day  are,  as  a  people,  the  most 
widely  educated,  the  most  philosophical,  and  per- 
haps the  most  wise  in  practice.  It's  fair  to  say 
that  more  than  half  of  them  are  Socialists.  Our 
own  present  industrial,  economical,  and  social 
condition  is  not  so  fine  that  we  should  wish  to 
perpetuate  it.  Through  trade  and  class  prejudices 
the  groups  of  our  people  are  drifting  further  and 
further  apart.  Compared  with  what  the  fathers 
of  the  Republic  knew,  the  present  industrial  situa- 
tion is  horrible. 

"IVe  just  been  reading  some  stuflF  in  a  Boston 


The  Doctor  is  a  Patient  135 

newspaper.  The  writer  assures  us  that  the  *  Pro- 
gressive movement  is  responsible  for  the  strike/ 
Then  he  goes  on  to  say:  'All  agree  that  the  strike 
is  a  symptom  of  advancing  Socialism.  .  .  .  The 
appeal  to  the  passions  of  the  mob  is  bred  by  the 
demagogic  propaganda  of  the  La  Follettes,  the 
Hearsts,  the  Fosses,  and  others  of  their  ilk,  who 
would  destroy  the  basic  principles  of  Government.' 
What  do  you  suppose  the  simple  lunatic  thinks  he 
means  by  basic  principles  of  government?  The 
framers  of  our  Federal  Constitution  had  no  inten- 
tion of  establishing  an  industrial  order  that  puts 
millions  of  women  and  children  practically  at  the 
mercy  of  a  few  gigantically  rich  capitalists.  Then 
our  friend  the  newspaper  man  goes  on  to  write  these 
glowing  words :  'The  present  progressive  movement 
is  a  movement  in  the  direction  of  Socialism.  The 
strike  was  not  needed  to  prove  that.  .  .  .  Those 
who  believe  in  Socialism  will  help  the  movement 
along.  Those  who  believe  in  the  established  order 
will  halt  while  there  is  time.'  Words,  words, 
words,  you  see." 

At  this  Ely  began  to  grumble  a  little:  "I  think 
you're  too  hard  on  our  Congressmen.  They're  not 
such  a  bad  lot  of  fellows.  And  as  for  the  newspaper 


136  A  Doctor's  Table  Talk 

writer,  —  I'm  much  inclined  to  agree  with  him. 
All  this  talk  about  tearing  up  the  Constitution  is 
terrifying  to  us  old  fellows." 

"I  don't  want  to  tear  up  the  Constitution," 
Primrose  almost  shouted.  "I  want  to  see  some- 
thing done  to  wipe  out  some  of  the  terrible  dis- 
parity of  living.  Our  history  books  tell  a  dreadful 
story  about  the  conditions  in  France  before  the 
Revolution.  I  declare,  except  for  the  presence  of 
the  ballot,  the  conditions  in  some  of  our  mill  towns 
to-day  are  not  so  very  different.  When  you  see 
employed  operatives  shivering  and  starving  in 
*good  times,'  and  their  daughters  by  the  thousands 
driven  to  the  life  of  the  street,  you  know  that  some- 
thing is  wrong.  You  have  no  right  to  draw  the 
shutters,  comfortably  to  fold  your  hands,  and  settle 
down  before  the  fire,  in  the  face  of  these  things.  I 
sometimes  think  that  the  man  who  does  so  is 
either  a  fool  or  a  traitor;  and  yet  I  don't  think  that 
I  am  a  ranter  or  a  demagogue. 

"But  let  us  get  away  from  this  alarming  side 
of  the  subject.  I  don't  yet  feel  equal  to  it.  There 
are  mild  questions  involved,  rather  academic  of 
their  kind.  In  the  Presidency  of  Washington,  who 
seems,  by  the  way,  to  have  been  one  of  the  richest 


The  Doctor  is  a  Patient  137 

men  in  the  country,  the  distinction  between  his 
rate  of  living  and  that  of  the  poorest  New  Hamp- 
shire farm  laborer  was  measurable.  Each  had 
enough  to  eat  and  enough  to  wear;  perhaps  the 
luxuries  of  the  one  were  the  necessities  of  the  other. 
But  the  brain,  the  abilities,  and  the  services  of  the 
one  were  immeasurably  greater  than  those  of  the 
other.  The  same  was,  as  a  rule,  true  of  all  prosper- 
ous men  in  those  days.  There  resulted  none  of 
that  class  bitterness  which  we  know.  The  wealthy 
merchant,  the  squire,  the  parson,  the  farmer,  and 
the  laborer  met  on  equal  terms  at  the  store  or  the 
tavern,  and  a  kindly  harmony  prevailed.  The  poor 
man  recognized  facts  and  limitations. 

"The  present  disparity  between  the  lots  of  the 
highest  and  the  lowest  is  so  great  that  it  seems  as 
though  it  could  not  long  endure:  Your  mill-opera- 
tive, the  father  of  a  family,  —  *  unskilled,'  he  is 
called,  —  earns  four  hundred  dollars  a  year;  your 
skilled  operative  earns  nine  hundred  dollars.  Mind 
you,  I'm  talking  averages;  not  about  the  fancy 
pay  of  such  specialists  as  locomotive  engineers, 
high-class  chauffeurs,  and  a  few  others.  At  the 
other  end  of  the  intellectual  scale  come  your  col- 
lege presidents;  men  who  lead  anxious,  responsible, 


138  A  Doctor's  Table  Talk 

laborious  lives,  —  your  Garfields,  Hydes,  Wilsons, 
and  Eliots ;  they  are  paid  from  jive  thousand  to  ten 
thousand  a  year.  Please  take  a  great  jump  now  — 
not  at  all  in  the  intellectual  but  in  the  pecuniary 
scale,  and  you  come  to  your  pork-packers,  your 
beef-barons,  your  captains  of  industry  in  steel,  oil, 
tobacco,  sugar,  and  the  like.  The  top  pay  among 
these  men,  —  and  they  are  truly  able  and  far- 
seeing,  the  best  of  them  shouldering  immense 
responsibilities,  and  toiling  always,  —  their  top 
pay,  including  of  course  the  return  on  investments, 
ranges  between  one  hundred  thousand  and  a  million 
dollars  a  year. 

"So  let  me  ask  you  again  the  old  question  not 
yet  truly  answered,  —  what  is  there  in  the  nature, 
the  intellect,  the  work,  or  the  services  of  one  of 
these  last  which  should  entitle  him  to  one  hundred 
times  the  pay  of  an  Eliot,  or  to  one  thousand  times 
the  pay  of  a  skilled  operative.'*  Is  our  system 
rational? 

"But,  you  will  say,  the  work  and  the  services 
of  an  Eliot,  and  of  thousands  of  other  devoted 
brain-workers  in  this  world,  cannot  be  measured 
by  dollars.  Exactly;  and  that  brings  me  at  last  to 
the  two  questions  in  this  Socialism  debate,  which 


The  Doctor  is  a  Patient  139 

I  have  never  heard  properly  discussed:  first,  is 
Individual  effort  to  be  measured  inevitably  by 
dollars?  and  second,  in  a  Socialistic  State,  would 
not  the  educational  opportunities  and  training  of 
all  the  citizens  be  fair  and  equal?"  ^ 

Upon  this  Ely  rose  up  in  very  wrath:  "Jonathan 
Primrose,  this  will  never  do.  Off  with  you  to  bed. 
It  is  ten  o'clock.  If  this  madness  continues,  we  may 
hear  you  again  to-morrow." 

*  It  appears  that  the  conceptions  of  present  day  advanced  So- 
cialists are  unfamiliar  to  Dr.  Primrose.  He  seems  to  talk  of  abol- 
ishing money,  and  cherishes  old-fashioned  popular  notions  and 
Utopian  dreams.  The  view  of  Socialism  as  an  enterprise  for  a  col- 
lective owning  of  the  tools  of  industry  and  a  collective  distribut- 
ing of  its  products  is  strange  to  him.  —  Scriba. 


CHAPTER  VII 

Dr.  Primrose  on  Socialism 

Sunday  is  still  a  day  seriously  to  be  observed  in 
Poquonnock  Village.  The  traditional  quiet  settles 
upon  the  lovely  valley.  You  may  hear  remote 
tinklings  from  the  distant  herd  upon  the  hills,  or 
down  the  rocky  road  the  lazy  shuffle  of  old  Joe 
and  Frank,  the  farm-horses  released  from  plow, 
bringing  the  family  to  the  meeting-house.  By  ten 
o'clock  the  place  is  all  astir,  and  scattered  groups 
collect  about  the  church,  —  the  postmaster  and 
his  wife,  the  keeper  of  the  country  store  with  his 
ten  children,  the  blacksmith,  the  carpenter,  the 
farmer-deacons  with  their  women-folk;  and  last, 
the  doctor's  family  —  friends  of  all.  Here  were 
Dr.  Primrose's  beloved  people,  of  whom  he  chose 
to  tell.  Of  all  the  world  their  fate  concerns  him 
most.  Two  generations  seem  to  have  gone  back; 
these  are  the  folk  of  sixty  years  ago.  One  thought 
almost  that  they  should  be  discussing  the  doings  of 
their  famous  neighbors,  Daniel  Webster,  Horace 


Dr.  Primrose  on  Socialism  141 

Greeley,  and  President  Franklin  Pierce.  Surely, 
says  the  doctor,  with  our  traditions  and  our  great 
names  on  the  state  roll,  the  glory  of  New  Hamp- 
shire must  return.  To-day,  of  course,  our  friend 
does  not  appear.  His  health  forbids.  His  anxious 
patients  ask  for  him,  and  smile  in  satisfaction  at 
the  news. 

True  to  his  patriarchal  character,  Dr.  Primrose 
is  an  old-fashioned  believer  in  revealed  religion, 
though  he  looks  for  increasing  tolerance,  and  prays 
sincerely  on  bended  knee  for  a  united  Christendom. 
Of  all  our  authors,  perhaps  he  loves  best  Sir 
Thomas  Browne,  whose  wise  lines  he  recites: 
"Holy  water  and  Crucifix  deceive  not  my  judge- 
ment, nor  abuse  my  devotion  at  all.  I  am,  I  con- 
fess, naturally  inclined  to  that  which  misguided 
Zeal  terms  Superstition.  My  common  conversa- 
tion I  do  acknowledge  austere.  .  .  .  Yet  at  my 
Devotion  I  love  to  use  the  civility  of  my  knee,  my 
hat,  and  hand,  with  all  those  outward  and  sensible 
motions  which  may  express  or  promote  my  invisi- 
ble Devotion."  Our  kind  friend  has  a  joyous  faith; 
he  believes  his  fellow  men  to  be  loyal  and  sound, 
and  he  worships  his  God  always  in  such  words  as 
he  read  to  us  this  morning  at  family  prayers:  "The 


142  A  Doctor's  Table  Talk 

heavens  declare  the  glory  of  God;  and  the  firma- 
ment showeth  his  handiwork." 

Just  now,  however,  his  mind  is  sorely  tried,  and 
his  faith  in  man  put  to  the  test.  To  him  fair  play 
and  honest  sportsmanship  are  a  second  religion,  and 
he  fears  that  the  group  of  money-making,  potent, 
forceful  men,  who  control  the  industries  and  the 
markets  of  the  world,  are  drifting  far  from  fair 
play  and  honest  sportsmanship.  He  even  whispers 
sadly  that  he  believes  some  of  them  to  be  not  only 
unpatriotic  but  dishonest.  He  thanks  Heaven  for 
the  hundreds  of  fine  exceptions.  He  quotes  the 
good  deeds  of  well-intentioned,  pathetic  restitu- 
tion —  as  he  calls  them  —  of  the  Goulds,  Car- 
negies.  Rockefellers,  and  the  like.  He  glories  in 
the  fine  career  and  noble  democratic  frankness  and 
fairness  of  such  a  man  as  Richard  F.  Crane;  not 
because  he  built  up  a  mighty  business  and  devised 
by  will  millions  to  his  employees,  but  because  he 
did  not  make  his  money  at  the  expense  of  his  fellow 
creatures.  I  remember  Primrose  quoting  from 
"Collier's  Weekly"  a  paragraph  about  Crane: 
"Once  he  noticed  that  some  of  his  men  were  doing 
sand-blasting  with  helmets  on  their  heads.  It 
seemed  to  him  an  unhealthy  occupation,  and  he 


Dr.  Primrose  on  Socialism  143 

ordered  a  change  to  a  method  much  less  profitable 
to  himself.  Frequently  he  told  his  branch  managers 
not  to  push  business  too  hard  in  competition  with 
weaker  opponents.  ...  It  was  his  principle  and 
his  practice  never  to  be  hard  towards  employees, 
competitors,  or  public.  Although  he  lived  to  see 
his  business  become  enormous,  he  never  regularly 
retained  a  firm  of  lawyers.  He  did  not  fight  his 
fellow  creatures,  but  helped  them.  .  .  .  He  never 
asked  or  needed  tariff  favors.  He  was  an  honor  to 
the  business  world  and  to  the  country  in  which  he 
lived." 

A  fine  act  need  not  be  conspicuous  in  order  to 
stir  Primrose  to  the  depths;  indeed,  one  of  his 
favorite  occupations  is  the  collecting  from  obscure 
newspaper  columns  accounts  of  self-sacrifice  and 
devotion  among  the  humble  and  unknown.  His 
is  a  whole-souled  patriotism.  He  cannot  endure 
long  to  be  absent  from  his  native  land  and  his 
home  state;  and  with  Van  Dyke,  — 

"His  Heart  is  turning  back  again  to  God's  countrie." 

He  is  no  captious  critic,  no  agitator,  no  dissatis- 
fied and  jaundiced  growler.  He  envies  no  man  his 
success,  for  he  has  a  proud  and  wholesome  con- 


144  ^  Doctor's  Table  Talk 

sciousness  that  his  own  life  has  not  been  lived  in 
vain.  He  knows  his  country's  story.  He  glories  in 
her  achievements;  he  sorrows  over  her  errors;  and 
he  holds  her  great  men  in  almost  idolatrous  vener- 
ation. For  him  the  names  of  Washington,  Hamil- 
ton, Lincoln,  and  anon  of  Lee  and  "Stonewall" 
Jackson,  bring  a  flush  of  the  cheek  and  a  fine  lift 
of  the  head.  He  never  tires  in  hearing  and  reading 
about  them.  He  prefers  the  society  of  the  immor- 
tals. 

What,  then,  shall  he  say  of  the  sorrows  which 
latterly  have  come  upon  the  land."*  His  optimism 
tells  him  that  perhaps  the  worst  is  over,  and  that 
we  are  passing  out  from  the  shadows;  but  he  sees 
continually  about  him,  and  in  the  midst  of  smiling 
peace,  fresh  evidences  of  man's  inhumanity  to  man. 
So  he  looks  always  for  new  light;  he  shocks  conserv- 
ative ears,  and  mingles  wisdom  with  hypotheses. 

That  Sunday  afternoon  he  joined  us  on  the  broad 
piazza  In  the  warm  spring  sunshine.  We  looked 
down  across  the  prosperous  valley,  and  at  the 
rolling  line  of  the  Sandwich  range  lifted  in  middle 
distance.  Dr.  Primrose  was  feeling  unusually  well, 
vigorous,  and  cheerful,  and  soon  the  conversation 
was  where  he  wanted  it,  in  his  own  hands. 


Dr.  Primrose  on  Socialism  145 

"William  Ely,  you  maltreated  me  last  night; 
and  now  you  must  listen  to  more  Socialism  talk. 
I  'm  looking  for  light  as  I  told  you ;  and  so  the  first 
thing  that  surprises  me,  when  I  hear  men  denounc- 
ing Socialism,  is  their  confident  assertion  that  it 
would  destroy  individualism  and  personal  efi"ort. 
I  suppose  they  have  some  sort  of  nebulous  idea 
that  in  a  Socialistic  society  all  men  who  so  choose 
could  sit  idly  about  in  armchairs  and  smoke 
Havana  cigars  at  the  expense  of  the  State.  That  is 
to  say,  the  ordinary  money  rewards  of  labor  being 
removed  or  minimized,  there  would  be  no  incentive 
to  labor.  Or,  to  put  it  more  grossly,  they  believe 
that  money  is  the  only  incentive  to  labor.  Let  me 
say  parenthetically  that  I  don't  propose  to  discuss 
the  detailed  constitution  of  a  Socialistic  State.  No 
one  is  doing  that  yet,  understandingly,  I  fancy. 
But  I  do  question  and  protest  against  the  assump- 
tion that  money  is  the  one  reward  of  effort.  The 
history  of  the  race  bears  out  no  such  assumption. 
Money  is  a  recent  invention  in  human  evolution; 
it  is  merely  our  present  conventional  medium  of 
exchange  in  the  markets  of  the  world. 

"Even  among  our  most  commonplace  moderns, 
however,  money  is  not  the  only  reward  of  effort. 


146  A  Doctor's  Table  Talk 

It  is  not  the  one  thing  which  we  most  seek  in  order 
to  fend  off  individual  degeneration.  I  Hke  to  think 
of  those  prizes  which  stimulate  the  young  before 
they  begin  to  take  their  part  in  the  sordid  dollar- 
scramble.  The  *  generous  delusions  of  youth/  by 
the  way,  don't  coincide  with  dollar-grabbing.  The 
child  in  the  nursery  looks  for  prizes  and  rewards 
in  return  for  effort.  He  finds  them  in  the  approba- 
tion of  his  parents  and  the  smiles  of  his  nurse. 
The  school-boy  is  rewarded  for  good  work  by  the 
joy  of  competition;  by  advancement  in  his  classes; 
by  the  respect  of  his  mates;  and  perhaps  by  medals, 
books,  and  the  like;  or  in  the  athletic  field,  by  dis- 
tinction in  games,  by  selection  for  important  teams, 
by  the  generous  applause  of  friends  and  rivals. 
As  the  boy  becomes  a  man,  he  continues  for  a  long 
time  to  look  for  similar  distinctions.  He  does  not 
shout  at  once  for  money.  If  he  is  in  college,  or 
learning  a  trade,  or  merely  leading  a  social  life,  he 
strains  for  and  finds  many  sorts  of  prizes,  not  least, 
perhaps,  the  wife  whom  he  wins  through  struggle. 
"You  will  say,  perhaps,  that  these  are  all  per- 
sonal and  selfish  rewards.  That  saying  is  largely 
true  of  the  rewards  of  the  young,  with  their  limited 
vision;  but  you  will  admit  that  the  rewards  of 


Dr.  Primrose  on  Socialism  147 

broadening  maturity  take  on  a  different  bearing. 
Of  course  there  are  always  the  prizes  of  personal 
satisfaction;  in  medicine,  for  example,  satisfaction 
in  the  confidence  and  goodwill  of  one's  commu- 
nity, in  the  securing  of  distinguished  and  cov- 
eted appointments  in  schools  and  hospitals,  and 
in  the  country-wide  professional  recognition,  per- 
haps, which  comes  with  years  of  increasing  effort 
and  solid  accomplishment  and  contribution;  but 
far  more  than  these,  though  intimately  concerned 
with  such  personal  good  things,  are  those  imper- 
sonal, undefinable  rewards,  —  in  satisfaction  with 
a  life-work  effectively,  proudly,  and  generously 
done;  perhaps  for  the  benefit  of  the  many,  and  for 
the  well-being  of  the  State. 

"Of  course,  in  every  walk  of  life  and  in  every 
vocation  there  are  great  rewards.  If  you  are  a 
blacksmith,  is  it  not  well  to  be  the  best  blacksmith; 
or  if  a  plumber,  the  best  plumber.?  On  the  other 
hand,  in  the  countless  industrial  occupations  of 
the  modern  world,  through  a  narrow  specializing, 
much  is  being  done  to  stifle  individualism;  as  a 
result  thousands  of  workers  hate  their  jobs.  To 
meet  this  sad  fact.  It  should  be  the  effort  of  em- 
ployers and  of  labor  organizations  to  see  to  it  that 


148  A  Doctor's  Table  Talk 

cramping,  narrowing,  stultifying  work  is  varied 
in  every  possible  fashion,  for  the  sake  of  the 
physical  and  intellectual  development  of  the  in- 
dividual. 

"  In  discussing  the  rewards  of  life,  however,  and 
the  non-monetary  prizes  towards  which  men  and 
women  may  strive,  we  need  not  conceive  of  imag- 
inary or  merely  possible  situations.  We  have 
already  in  our  midst  two  great  bodies  of  men,  who 
are  incessantly  and  actively  concerned  for  their 
own  *  Services'  and  for  their  country;  I  mean  the 
officers  of  the  army  and  navy.  To  me  there  is 
something  peculiarly  fine  in  the  unselfish  devotion 
and  the  unrewarded  service  of  the  thousands  of 
those  men.  When  a  young  lieutenant  with  his 
little  company  follows  a  gang  of  Indian  murderers 
for  weeks  through  the  desert,  brings  them  to  bay, 
destroys  them,  and  relieves  the  frontier  of  an 
ancient  terror,  he  is  not  looking  for  dollars.  When 
a  naval  commander,  in  a  converted  yacht,  attacks 
a  squadron  of  three  times  his  power,  or  sinks  his 
vessel  at  the  mouth  of  a  hostile  harbor  beneath  the 
guns  of  the  enemy;  or  when  a  general  officer 
pacifies  a  turbulent  island,  restores  order,  com- 
poses the  abuses  of  generations,  brings  stability 


Dr.  Primrose  on  Socialism  149 

and  prosperity,  and  wipes  out  a  ghastly  endemic 
scourge,  he  does  it  all  because  it  is  his  duty  and  in 
spite  of  the  criticism,  or  grudging  recognition,  of 
his  ungracious  fellow  citizens.  Look  at  Goethals 
and  Gorgas  in  Panama,  —  one  accomplishing, 
successfully,  superbly,  and  in  briefest  time,  the 
greatest  piece  of  engineering  in  history;  the  other 
making  that  work  possible  by  turning  a  notorious 
pest-hole  of  the  tropics  into  a  salubrious  winter 
resort,  and  keeping  in  the  field  with  unimpaired 
health  the  thousands  of  laborers  needed  for  the 
mighty  work. 

"Are  Goethals  and  Gorgas  looking  for  dollars.^ 
Surely  not  they;  and  yet,  I  tell  you,  they  shall  have 
their  reward. 

"It  was  Emerson  who  wrote  the  homely  but 
delightful  words : '  If  a  man  can  write  a  better  book, 
preach  a  better  sermon,  or  make  a  better  mouse- 
trap than  his  neighbor,  the  world  will  make  a 
beaten  path  to  his  door.' 

"Of  course  you  will  say  that  all  this  is  very  true 
of  selected  and  heroic  groups,  but  what  is  to  keep 
the  average  man  up  to  his  work.f"  I  take  it  that 
community  interest,  public  sentiment,  and,  above 
all,  education,  must  be  relied  upon.  Of  course  I 


150  A  Doctor's  Table  Talk 

have  no  Utopian  dreams  of  a  perfected  human 
nature.  There  will  always  be  weak,  pathetic,  and 
degenerate  souls,  I  suppose.  But  when  you  con- 
ceive of  the  State  as  a  great  family,  you  will  see 
that,  in  the  course  of  a  very  few  years,  —  three 
or  four  generations,  —  our  individual  types  will  be 
of  a  greatly  higher  average,  and  the  unfortunates 
much  fewer.  It  is  not  difficult  to  conceive  of  a 
people  among  whom  there  shall  be  no  acute  epi- 
demic disease;  no  tuberculosis;  no  cancer,  no  alco- 
hol; no  foul,  unmentionable  contagions;  and  as  a 
result  few  or  no  congenital  deformities,  nervous 
diseases,  insanities,  criminal  tendencies,  and  other 
handicaps  to  individual  and  community  progress. 
This  is  not  a  pipe-dream  or  a  vision ;  it  is  the  fore- 
cast of  a  situation  which  we  are  surely  to  bring 
about  with  or  without  Socialism.  And  when  that 
time  comes,  when  we  have  to  deal  with  a  thor- 
oughly sane,  alert,  educated,  physically  sound 
community,  then  will  we,  indeed,  be  the  greatest 
of  nations,  and  be  in  a  position  to  abolish  the  wars 
which  still  reveal  our  barbarism,  and  terrify  and 
disgrace  our  civilization. 

"Such  an  outcome  of  concerted  altruistic  en- 
deavor should  be  no  farther  from  us  than  we  are 


Dr.  Primrose  on  Socialism  151 

from  the  French  Revolution.  Perhaps,  though,  I 
have  not  yet  answered  your  question,  Ely:  in  a 
Socialistic  State  what  is  to  keep  the  individual 
citizen  in  line?  I  have  shown  that  the  naughty 
fellows  who  need  to  be  kept  in  line  will  be  few  in 
number,  if  all  goes  well  with  us;  and  I  have  hinted 
at  a  system  of  rewards  and  punishments.  Some- 
thing of  that  kind  there  must  be.  A  State  whose 
public  business  is  so  all-embracing  as  the  one  we 
are  considering  must  take  official  notice  of  the  good 
or  bad  lives  of  its  citizens.  There  exists  to-day  an 
interesting  institution,  popularly  known  as  the 
*  Carnegie  Hero  Fund.'  It  is  administered  by  a 
committee.  One  conceives  easily  that  such  a  com- 
mittee might  be  multiplied  so  as  to  concern  itself 
with  many  and  diverse  interests. 

"  You  will  remind  me  how  it  is  a  matter  of  com- 
mon observation  that  public  enterprises,  public 
interests,  and  public  utilities  are  to-day  far  more 
economically  and  efficiently  administered  by  pri- 
vate corporations  than  by  public  officials.  I  admit 
it,  but  from  that  you  cannot  augur  eventual  failure 
of  community-directed  interests.  We  anticipate 
vast  improvements,  first,  in  public  health,  in  public 
education,  in  public  morals,  and  in  public  coopera- 


152  A  Doctor's  Table  Talk 

tlon.  Then  we  can  look  safely  for  increased  public 
efficiency. 

"All  that,  again,  is  parenthetical.  We  were  speak- 
ing of  rewards  and  punishments.  In  an  important 
sense,  of  course,  punishments  must  always  exist. 
The  undesirable  citizen  must  be  taught  his  unde- 
sirability,  and  be  reformed  or  isolated.  The  fool, 
the  knave,  the  traitor,  the  ingrate,  the  indolent, 
cannot  receive  the  recognition  and  compensation 
of  the  honest  citizen;  but  that  is  a  matter  of  obvious 
detail. 

"Letmesay  a  fewmore  words.  There  is  one  funda- 
mental matter  to  which  I  have  already  alluded,  — 
universal  education.  I  do  not  mean  the  present 
popular  and  obligatory  education,  which  stops  with 
the  grammar  school  or  the  high  school;  which 
teaches  little  more  than  the  rudiments  of  English, 
and  of  popular  science,  and  produces  no  trained 
minds  whatever.  I  mean  a  higher  training,  which 
equips  the  student  with  intellectual  or  mechanical 
tools  and  an  accurate  knowledge  of  their  use.  Com- 
monly, in  the  Socialism  discussion,  disputants  lose 
sight  of  the  fact  that  every  single  member  of  the 
ideal  State  would  receive  a  high  intellectual  train- 
ing, so  far  as  he  is  capable  of  receiving  it,  —  some- 


Dr.  Primrose  on  Socialism  153 

thing  approximating  to  the  college  or  the  technical 
school  education  of  to-day.  This  conception  throws 
an  entirely  new  light  on  the  social  and  civic  prob- 
lem, for  we  should  then  be  dealing  with  a  group  of 
citizens  such  as  the  world  has  never  known,  and  this 
group  would  comprise  all  the  people. 

"  In  view  of  this  new  conception  of  an  educated 
people,  countless  new  and  unexpected  questions  — 
industrial  and  economical  —  arise.  I  will  hint  only 
at  these,  for  the  line  of  debate  is  obvious.  An  edu- 
cated critic  says,  —  What's  going  to  become  of  the 
rough,  unskilled,  manual  work  of  the  State,  if  all 
your  citizens  are  accomplished  technicians?  My 
friend,  the  thought  should  make  you  gasp  for  joy. 
Did  you  ever  go  on  a  camping,  surveying,  fishing, 
or  shooting  expedition  with  a  group  of  men  of  your 
own  kind.'*  I  have.  One  man  may  have  charge  of 
the  wagon,  another  of  the  horses,  another  of  the 
tents,  another  of  the  dish-washing,  and  so  on. 
Whose  is  the  rough,  unskilled  work  there  ?  and  who 
cares  ?  Work  is  worthy  or  unworthy,  skilled  or  un- 
skilled, onerous  or  joyous,  according  to  community 
conventions,  and  the  zeal,  training,  and  ability  of 
the  worker.  If  a  trained  man  be  set  to  run  a  fur- 
row, dig  a  trench,  or  sweep  a  crossing,  he  will 


154  ^  Doctor's  Table  Talk 

quickly  develop  methods  of  accomplishing  his  task, 
5uch  as  the  age-long,  grudging  inefficiency  of  the 
untrained  would  never  accomplish.  The  highly 
trained  men  of  our  ideal  State,  with  their  tradi- 
tions of  culture  and  mutual  support,  should  develop 
an  intelligence  and  a  reasonableness  such  as  would 
move  mountains.  Co5perative  efficiency  also  would 
be  developed  to  a  high  level,  hours  of  work  and  of 
needless  effort  would  be  minimized;  time  would  be 
allowed  all  men  for  recreation  and  cultivation,  and 
new  joys  of  life  and  new  powers  of  human  happiness 
would  come  into  being,  as  I  do  believe." 

He  stopped,  tired  with  much  talking. 

"Well,  my  dear  Jonathan,"  said  Ely  at  last, 
"you  have  certainly  been  reading  and  thinking  to 
some  purpose.  You  are  as  much  of  a  dreamer  as 
ever,  and  I  admit  that  your  dreams  are  sometimes 
beautiful.  Of  course,  the  one  obvious  reply,  for 
hard-headed  persons  like  Scriba  and  myself,  who 
are  constantly  encountering  the  facts  of  life,  is  that 
men  like  you  ignore  the  actual  weakness,  the  in- 
herent wickedness,  and  the  brutality  of  humanity. 
You're  talking  of  Utopia,  of  course,  but  the  sad 
thing  Is  that  you  seem  truly  to  look  for  It.  Scriba 
here  was  right,  too,  long  ago,  when  he  told  Flaxman 


Dr.  Primrose  on  Socialism  155 

that  only  by  becoming  a  professional,  by  learning 
to  depend  on  himself  alone  for  a  living  and  advance- 
ment, only  so  could  he  put  off  childish  things,  at- 
tain maturity,  and  'arrive.'  Your  ideal  Socialistic 
community  seems  to  me  especially  designed  to 
undermine  and  sap  individualism,  and  to  cut  out 
that  tough  fibre  which  is  needed  for  character- 
building;  and  you  misrepresent  present  Socialistic 
tendencies.  You  Ve  gone  back  to  Bellamy's  *  Look- 
ing Backward.' 

"As  for  that  strike  which  gives  you  a  text  for 
your  sermon,  —  you  should  hear  some  of  the  people 
in  the  city  talk  about  it.  They  may  not  be  well 
informed,  but  they  are  far  better  informed  than  the 
frantic  strike  leaders,  and  the  pathetic,  ignorant 
mobs  who  follow  them.  The  city  people  of  whom  I 
speak  are  kindly  and  generous,  as  their  deeds  do 
testify.  Many  of  them  are  stockholders  in  those 
very  mills.  Many  of  them  have  sons  in  the  troop  of 
mounted  militia,  which  has  been  sent  down  to  as- 
sist in  keeping  order,  and  in  protecting  property. 
They  tell  me,  from  practically  first-hand  knowledge, 
that  the  state  of  things  in  that  mill-town  is  truly 
shocking,  a  grave  menace  to  individual  property 
rights,  and  a  most  serious  danger  to  civil  govern- 


156  A  Doctor's  Table  Talk 

ment.  They  say  that  the  strike  leaders  are  ferocious 
and  unreasoning,  while  the  maddened  strikers  — 
half-starved,  and  lashed  by  anarchistic  talk  — 
are  like  packs  of  wild  creatures,  ready  for  any  bru- 
tality, mischief,  or  violence." 

"  Well,  well,"  returned  our  host,  with  a  smile, "  we 
are  far  enough  from  Utopia  as  yet.  I  fancy  we  all 
need  educating  on  new  lines.  I  believe,  too,  that 
you  are  correct,  —  that  human  nature  is  still  much 
what  it  was  two  thousand  years  ago,  though  Black 
Care  may  not  sit  behind  those  joyous  young  horse- 
men, whose  anxious  mothers  have  sent  them  off 
to  put  down  the  strike." 

The  Sunday  afternoon  was  waning.  Dusk  was 
falling.  Scattered  fires  sprang  into  light  on  distant 
hillsides  across  the  valley.  The  farmer  was  again 
abroad;  tidying  his  fields  and  roads,  and  burning 
the  gathered  "brush." 

As  Primrose  watched  the  familiar  and  pensive 
scene,  a  twinkle  of  mirth  shone  in  his  kindly  eyes 
and  lighted  his  earnest  face.  "I  love  a  fire,"  he 
said.  "Who  does  not?  What  a  marvelous  thing 
it  must  have  been  to  our  far-away  ancestors,  when 
they  discovered  it.  No  wonder  they  worshiped  it. 


Dr.  Primrose  on  Socialism  157 

From  those  idolators  down  to  Charles  Lamb,  every 
lover  of  his  kind  has  loved  a  fire;  and  every  man 
has  loved  best  the  fire  of  his  own  making.  Often  I 
have  speculated  idly  as  to  how  those  prehistoric 
fires  first  were  lighted.  Did  some  freak  of  nature, 
some  volcanic  outburst,  or  the  dregs  thereof,  sug- 
gest the  uses  of  fire  to  the  shivering  cave  men .?  Or 
did  primitive  man  create  fire  by  the  friction  of 
wood,  or  by  the  blow  of  flint  on  metal?  Certainly 
it  seems  to  be  that  the  domestic  fire,  the  purposeful 
fire,  is  the  work  of  man.  No  most  superior  animal 
ever  truly  understood  it,  or  adopted  it  of  himself; 
while  no  tribe  of  men,  even  the  most  ignorant, 
savage,  and  debased,  now  lacks  the  fire. 

"Of  all  fires  the  fire  of  the  personal  hearthstone 
is  the  most  precious;  and  each  one  of  us  builds, 
cherishes,  and  tends  his  own  fire  with  the  care  that 
he  bestows  upon  a  child.  He  is  jealous  for  its  repu- 
tation; he  delights  in  its  peculiar  symmetry  or 
eccentric  activities;  and  his  soul  resents  for  it  the 
unsympathetic  mending  and  the  rude  and  bump- 
tious touch  of  the  unfamiliar  hand.  There  are 
fundamental  principles  common  to  the  building 
of  all  fires,  but  each  one  of  us  gives  his  own  fire  a 
peculiar  and  personal  flavor.   As  there  are  princi- 


158  A  Doctor's  Table  Talk 

pies  which  underlie  the  building  and  starting  of  a 
fire,  so,  too,  are  there  principles  which  underlie 
the  keeping  of  it  up.  Did  it  ever  occur  to  you  that 
four  creatures  or  elements  enter  into  the  construc- 
tion of  every  fire?  The  tools  of  ignition,  for  which 
we  employ  the  homely  match ;  the  tinder,  for  which 
discarded  newspaper  may  best  suffice;  the  'kind- 
lings,' with  us  finely  split  strips  of  driest  wood ;  and 
finally  the  permanent  coals,  or  ^cordwood,'  which- 
ever we  may  choose.  For  me  the  open  fire  of  wood 
alone  possesses  charm,  and  coals  bituminous  con- 
cern me  not.  A  wide  and  deep  chimney  and 
hearth,  with  perfect  draft,  are  first  essentials,  too; 
andirons  not  high,  and,  banked  upon  the  hearth, 
a  clean  and  copious  bed  of  ashes,  of  many  weeks' 
burning,  piled  nearly  to  the  level  of  the  *dogs.' 
Two  difi"erent  constructions  I  do  affect,  though 
similar  in  principle:  a  large  round  back-log  behind 
the  *  dogs';  in  front  of  it,  much  crumpled  tinder 
lightly  strewn;  down  from  the  log,  a  sloping  thatch 
of  kindlings;  and  then  above,  two  large  split  logs  to 
catch  the  early  blaze.  Or  else,  two  split  logs  laid 
upon  the  irons,  a  six-inch  space  between;  below  and 
then  between,  abundant  paper  laid;  from  log  to  log 
a  copious  roof  of  sticks,  supporting  well  a  third, 


Dr.  Primrose  on  Socialism  159 

split,  trusty  log.  So  placed,  a  roar  of  flame  lights 
up  the  hearth,  and  if  the  wood  be  dry,  a  glorious 
fire  springs.  You  see  that  at  the  start  we  deal  with 
elements  all  cold;  for  these,  wide  space  and  generous 
drafts  play  an  important  part. 

"For  me,  however,  tending  and  mending  of  the 
fire  when  burning  full,  or  flagging,  is  of  the  greatest 
joy:  the  keeping  narrowed  spaces,  gentle  drafts; 
approaching  glowing  face  to  glowing  face,  without 
too  rudely  and  by  jealous  chinks  excluding  air; 
dropping  the  fore-log  now  upon  the  hearth;  raising 
an  end  or  raking  embers  down;  Inserting  curious 
charred  and  gleaming  bits  beneath  their  mighty 
fellows  freshly  piled;  watching  the  smoke  outpour; 
the  streak  of  flame  updart,  then  vanish,  then  en- 
dure with  steady,  buoyant,  life-returning  zeal; 
this  is  serene  contentment.  Build  me  no  fires;  let 
me  tend  mine  own." 


CHAPTER  VIII 

Reflections  —  Ambrose  Pare 

"'The  atrocious  crime  of  being  a  young  man, 
which  the  honorable  gentleman  has,  with  such 
spirit  and  decency,  charged  upon  me,  I  shall  neither 
attempt  to  palliate  nor  deny;  but  content  myself 
with  wishing  that  I  may  be  one  of  those  whose  fol- 
lies may  cease  with  their  youth,  and  not  of  that 
number  who  are  ignorant  in  spite  of  experience.* 
What  public  man  to-day,"  added  Dr.  Primrose, 
"has  the  wit  or  the  ability  to  write  such  English  as 
that.  No  wonder  old  Robert  Walpole  slunk  away 
from  the  fierce  assaults  of  the  terrible  young  Cornet 
of  Horse." 

It  was  the  Monday  of  our  week-end  visit,  but 
Ely  and  I  still  tarried.  Our  host's  returning  cheer- 
fulness and  vigor,  his  inspiring  vitality,  and  his 
almost  pathetic  hunger  for  the  audience  of  a  life- 
time, induced  us  to  stay  with  him  in  his  sunny  bed- 
room. He  was  speaking  of  current  literature,  es- 
pecially of  the  newer  writers  of  fiction. 

"In  spite  of  that  famous  saying  of  Pitt's,  which 


Reflections  —  Ambrose  Pare  1 6 1 

old  Samuel  Johnson  Is  said  to  have  prepared  for 
him,  the  fact  remains  that  the  season  of  youth  is 
not  always  one  of  wisdom,  even  among  novel 
writers.  There's  a  young  Englishman,  Arnold 
Bennett,  whose  writings  are  said  to  be  having  an 
enormous  sale.  He  is  clever  and  Industrious,  but 
utterly  without  humor  or  a  sense  of  perspective. 
I  read  through  two  of  his  books  last  winter,  though 
I  don't  know  why.  He  is  that  difficult  thing  to 
define,  a  realist,  whatever  he  himself  means  by  the 
word.  He  Is  said  to  boast  of  the  amount  of  work  he 
is  able  to  turn  off.  He  seems  to  produce  'literature' 
by  the  foot.  Lately  he  spent  two  or  three  weeks  in 
America  to  study  us.  He  was  extremely  well 
advertised,  and  even  to  the  end  he  submitted  kindly 
to  interviews. 

"Of  course  his  remarks  about  America  are  of  no 
value,  and  are  not  even  Interesting;  but  his  notions 
about  literature  have  a  certain  value,  because  they 
are  the  notions  of  many  modern  readers,  who  are 
partly  educated  without  being  trained.  This  young 
man's  conceit  Is  colossal,  though  that  Is  merely  by 
the  way.  He  appears  to  think  well  of  some  of  our 
own  short  story  writers;  but  it  Is  when  he  gets  to 
rattling  about  among  the  Immortals  that  he  takes 


i62  A  Doctor's  Table  Talk 

away  your  breath.  He  is  said  to  acknowledge  the 
genius  of  Henry  Fielding;  he  is  willing  even  to 
speak  a  kind  word  for  good  old  Richardson;  but  for 
the  past  hundred  and  fifty  years,  he  finds  no  writer 
of  any  particular  distinction  until  he  comes  to 
Hardy.  Scott,  Charlotte  Bronte,  Dickens,  Thack- 
eray, George  Eliot  he  groups  as  second-rate  artists, 
as  mere  sentimentalists. 

"That  is  the  word  we  are  waiting  for,  my  friends. 
That  expresses  the  idea  which  shocks  and  con- 
founds the  muddy-minded  realist.  Sentiment  to 
him  is  as  naught.  It  finds  no  place  apparently  in 
his  vocabulary  or  in  his  life.  What  a  distorted  half 
vision  of  history  and  of  our  little  world  must  be 
his,  for  it  is  Sentiment  that  distinguishes  us  from 
men  of  the  Stone  Age,  and  from  the  lower  animals. 
What  has  not  Sentiment  accomplished  in  the  world 
'of  men."*  It  was  Sentiment,  true  or  false,  that 
prompted  the  Psalms  of  David ;  that  inspired  Bud- 
dha and  the  Hebrew  seers  to  the  construction  of 
great  religions;  that  provoked  the  awful  crime  of 
Calvary;  that  led  the  footsteps  of  St.  Paul;  that 
established  and  extended  the  Christian  Church; 
that  inspired  the  Crusades,  that  confirmed  the 
Reformation;  that  led  thousands  to  martyrdom; 


Reflections  —  Ambrose  Pare  163 

that  made  real  civil  liberty  and  political  freedom 
in  England,  America,  and  France;  that  put  an  end 
to  slavery;  that  liberated  Cuba,  and  is  now  eman- 
cipating industrial  mankind;  these  are  a  few  of 
the  results  of  Sentiment.  The  thoughts  come  to  one 
offhand.  Something  of  the  story  is  hinted  by  Ben- 
nett's second-rate  artists,  the  Sentimentalists.  I 
fancy  their  works  will  live,  and  that  future  genera- 
tions will  thrill  at  the  tale  they  have  to  tell.  Is  the 
world  no  better  or  happier  for  'Ivanhoe,'  for  'Jane 
Eyre,'  for  'David  Copperfield,'  for  Colonel  New- 
come  and  for  Maggie  TuUiver,  or  must  we  seek  in- 
spiration and  literary  satisfaction  in  'Clayhanger* 
and  in  'Tess'.? 

"To  return  to  our  own  work,  —  did  it  ever 
occur  to  you  that  running  through  all  technical 
talk,  especially  doctor  talk,  there  is  a  sense  of  aloof- 
ness, as  though  our  training  and  our  interests  kept 
us  in  a  world  apart  from  all  the  others.  The  very 
word  'doctor,'  in  English  speech,  means  a  doctor 
of  medicine;  and  physician  is  implied,  unless  one 
specially  indicates  a  doctor  of  laws,  of  divinity,  of 
science,  or  of  letters.  We  physicians  are  expected 
to  perform  curious  wizard-like  feats,  and  if  we 
don't,  we  shatter  even  the  most  intelligent  confi- 


164  A  Doctor's  Table  Talk 

dence.  Not  long  ago  a  well-known  Boston  surgeon 
told  me  of  a  painful  experience.  It  seems  that  for 
some  fifteen  years  he  had  done  most  of  the  surgery 
in  the  town  of  Barchester — ten  miles  from  the  city. 
The  leading  family  physician  of  Barchester  had 
sent  for  him  to  see  scores  of  surgical  cases,  and  for 
years  his  work  in  the  town  was  almost  brilliantly 
successful.  He  looked  upon  that  physician  and 
those  townspeople  as  his  friends,  while  at  the  same 
time  he  drew  from  the  place  a  considerable  share 
of  his  professional  income. 

"Then  in  one  year  there  came  a  series  of  unavoid- 
able calamities :  he  operated  for  internal  abscess  on 
the  wife  of  a  well-known  broker,  taking  every  rea- 
sonable precaution.  That  very  night  an  old,  latent 
heart  trouble  recurred,  and  within  thirty-six  hours 
she  died  of  malignant  heart  disease.  Again  he 
operated  for  a  small  growth  on  another  well-known 
woman  in  Barchester.  The  anaesthetic,  as  always 
in  his  cases,  was  given  by  an  expert.  The  patient 
developed  pneumonia,  and  died  in  forty-eight 
hours.  Six  months  later,  he  operated  for  relapsing 
appendicitis  on  a  fourteen-year-old  schoolgirl,  the 
charming  daughter  of  his  consultant's  next-door 
neighbor.  The  child  never  rallied;  a  serious  kidney 


Reflections — Ambrose  Pare  165 

involvement  developed,  and  she  died  at  the  end  of 
a  week.  During  her  anxious  illness  her  physician 
told  my  friend  that  he  must  pull  the  child  through; 
that  she  must  not  die;  for  if  she  did,  not  only  would 
his  own  practice  be  seriously  damaged,  but  it 
would  be  impossible  for  him  ever  again  to  call  my 
friend  in  consultation.  That  forecast  has  been  veri- 
fied —  at  least  so  far  as  my  friend  the  surgeon  is 
concerned.  From  that  day,  now  two  years  ago,  he 
has  made  no  professional  visits  in  Barchester. 

"To  those  of  us  who  are  familiar  with  the  prob- 
lems of  disease,  and  with  the  chances  of  life  and 
death,  it  is  obvious,  of  course,  that  this  surgeon  was 
essentially  blameless.  Those  patients  would  have 
died  no  matter  who  operated,  and  they  would  prob- 
ably have  died  shortly  had  no  operation  been  done. 
Moreover,  this  same  man  had  to  his  credit  scores  of 
successful  operations  without  a  death;  but  these 
facts  weighed  not  at  all  with  the  terrified  family 
physician  and  his  demoralized  flock." 

"You  can't  blame  them,  though,"  said  Ely; 
"naturally  they  look  only  to  results.  The  ability, 
native  sense,  and  sagacity  of  a  surgeon,  his  years  of 
preparation,  his  anxious  days  and  nights,  his  heart- 
breaking experiences,  —  if  he  be  an  honest,  humble 


i66  A  Doctor's  Table  Talk 

man,  —  and  his  earnest,  unceasing  struggles  to  save 
the  particular  case,  —  all  go  for  nothing.  In  these 
respects,  I  admit  that  the  physician  has  an  im- 
mense advantage  over  the  surgeon.  If  the  physi- 
cian loses  a  patient,  the  fact  is  commonly  recog- 
nized as  an  act  of  God,  and  in  spite  of  endeavor. 
If  a  surgeon's  patient  dies,  the  unthinking  say  that 
the  surgeon  operated  and  killed  him.  Pleasant  for 
the  surgeon,  is  n't  it.''  and  yet  it's  a  reproach  he 
must  continually  meet." 

"The  only  way  out,"  replied  Primrose,  taking  up 
the  thought,  "lies  in  the  better  education  of  our 
public.  Harvard  is  doing  something  through  those 
weekly  *  Popular  Lectures,'  but  a  great  deal  is  still 
to  do.  For  one  thing  the  story  of  medicine  and 
of  medical  men  remains  to  be  written.  Technical 
historical  volumes  for  the  profession  have  been  com- 
piled by  the  dozen,  but  there 's  no  story  of  medicine 
for  the  average  reader.  That  is  true  of  few  other 
professions.  Law,  theology,  politics,  natural  science, 
engineering,  astronomy,  and  dozens  of  other  serious 
interests  have  been  brought  to  popular  libraries; 
but  the  story  of  medicine  and  physicians  is  un- 
known, even  to  physicians  themselves. 

"Last  winter,  while  dreaming  on  these  things, 


Reflections  —  Ambrose  Pare  167 

as  I  lay  for  months  In  bed,  I  thought  I  would  make 
a  little  beginning  of  such  popular  preaching,  by 
writing  down  briefly  and  simply  the  story  of 
Ambrose  Pare.  You  know  that  Pare  was  the  first 
conspicuous  clinical  surgeon  among  us  moderns. 
He  himself  tells  of  his  struggles  and  trials  in  a  very 
human  and  enlightening  fashion.  It  seemed  to  me 
that  the  story  of  his  life  might  well  introduce  the 
average  man  to  the  doctor's  manner  of  thought. 

"Here  is  my  little  manuscript.    Shall  I  read  it 
out.''  Yes?  Let  us  call  it 


Ambrose  Pare,  and  the  Dawn  of  Modern 
Surgery 

By  Jonathan  Primrosey  M.D. 

"  *  Now  let  there  be  the  merry  sound  of  music  and  the  dance 
Through  thy  corn-fields  green,  and  sunny  vines,  O  pleasant 
land  of  France.' 

"No  man  loves  his  country  more  than  does  the 
Frenchman,  and  never  did  Frenchman  love  France 
more  than  did  Ambrose  Pare.  He  was  a  lover  of 
his  kind  as  well.  He  was  the  great  and  simple 
democrat  of  sixteenth-century  Europe.  When 
Pare  first  saw  the  light,  the  modern  world  also  had 


i68  A  Doctor's  Table  Talk 

just  been  born,  and  he  lived  through  the  glorious, 
heroic,  and  terrible  years  of  its  struggling  child- 
hood. The  record  of  his  days  covers  almost  the 
whole  of  the  sixteenth  century  —  from  1510  to 
1590.  It  was  a  memorable  century  for  France, 
whose  great  writers  still  tell  the  story  with  wonder. 
The  Valois  kings  were  nearing  the  end  of  their 
erratic  course.  In  15 10  Louis  XII  was  still  upon 
the  throne,  —  unquestionably  to  us  moderns  the 
best  king  of  his  line,  —  and  France  was  still  en- 
joying something  of  the  calm  and  consequent  pros- 
perity which  the  two  preceding  reigns  had  brought. 
Those  were  times  of  curious  groping  change  in 
politics  and  in  life.  The  flowers  of  new  knowledge, 
sown  by  the  great  Italian  humanists,  were  begin- 
ning to  bloom  in  sheltered  gardens.  Old  knowledge 
was  being  brought  back;  and  neglected  science 
again  was  lifting  her  head.  Men  of  vision  were  look- 
ing abroad.  Printing  and  Luther;  the  magnetic 
compass  and  Columbus;  the  revival  of  the  English 
language  and  Latimer;  the  vast  student  migrations, 
Padua,  and  Vesalius  the  anatomist,  are  not  words 
of  mere  coincidence. 

"Again,  after  years  of  coma,  mankind  was  be- 
ginning to  think.   The  feudal  system  was  dying; 


Reflections  —  Ambrose  Pare  169 

old  things  were  passing  away;  intellect  was  begin- 
ning to  supplant  force;  the  common  people  were 
looking  about;  and  the  train  was  being  laid  which 
was  to  lead  through  years  of  blood  and  groans  to 
the  French  Revolution  and  the  claims  of  modern 
thought,  not  yet  perfected. 

"Conventional  historians  use  kings  and  queens 
as  milestones  with  which  to  measure  the  course 
of  history,  —  kings  and  queens  turned  pawns  in 
our  unkind,  modern  days.  For  us  still  kings  and 
queens  serve  well  enough  to  mark  eras  and  to  line 
off  the  centuries,  though  their  story  tells  us  little 
enough  of  the  true  makers  of  history  —  the  people 
of  the  land.  In  the  France  of  Ambrose  Pare  the 
people  of  the  land  were  abundantly  worth  knowing. 
Their  sixteenth-century  kings  we  remember  be- 
cause Dumas  talks  about  them  —  pathetic,  degen- 
erate, mischievous  young  fellows  mostly,  —  and 
Francis  I  leads  them,  with  his  foolish  beard,  his 
wild-Indian  boastings,  his  harem,  his  Field  of  the 
Cloth  of  Gold,  his  squabbles  with  English  Henry 
VIII  and  with  Charles  V  of  Spain,  —  Francis,  a 
man  now  notable  to  us  chiefly  because  he  began  to 
make  trouble  for  his  parliaments  and  to  restrict 
them  in  those  political  rights  which  his  two  im- 


170  A  Doctor's  Table  Talk 

mediate  predecessors  had  conferred.  In  Francis's 
time  Pare  found  an  education  and  service  as  a  field 
surgeon.  After  Francis  came  his  son,  Henry  II, 
who  brought  that  very  naughty  Catherine  de' 
Medici  to  France  as  his  queen  and  made  the 
famous  Diane  de  Poitiers  his  mistress.  That 
Catherine,  most  wicked  of  modern  women,  was  the 
mother  of  the  feeble  dandy  kings  who  made  a  foot- 
ball of  France  and  brought  to  an  end  the  Valois 
line  —  thanks  to  their  feeble  queens,  to  the  Hugue- 
nots, to  St.  Bartholomew,  and  to  Henry  of  Navarre. 

"Pare  was  surgeon  to  Henry  II,  the  gay  lover  of 
Diane;  he  saw  him  pierced  by  the  lance  of  Mont- 
gomery in  a  friendly  joust;  and  he  foretold  his 
death  when  he  perceived  that  the  lance-head  had 
deeply  penetrated  the  brain  through  the  orbit. 
The  king  died  in  his  early  forties,  and  was  suc- 
ceeded by  his  pathetic  son,  Francis  II,  whom  we 
remember  as  the  first  husband  of  our  Scotch  Mary 
Stuart,  and  the  victim  of  a  middle-ear  disease, 
which  produced  a  meningitis  and  carried  him  off 
in  the  second  year  of  his  reign,  —  Pare  again 
attending  and  protesting  against  the  follies  of  his 
medical  colleagues. 

"Then  came  Charles  IX,  —  he  of  St.  Bartholo- 


Reflections  —  Ambrose  Pare  171 

mew,  —  a  mock  heroic  sportsman,  clinging  to  his 
old  nurse,  and  to  Pare,  the  friendly  surgeon,  albeit 
they  were  Huguenots.  Pare  was  with  the  king 
to  the  last  of  his  fatuous  twenty-four  years  —  the 
surgeon  now  advanced  well  beyond  threescore. 
The  old  hero  was  aging  strongly.  Men  and  women 
loved  and  trusted  him.  He  stands  as  a  tower  of 
vigor,  honor,  and  charity  in  the  midst  of  that  fool- 
ish throng  of  wild  courtiers  and  jealous  physicians. 

"Henry  HI,  the  last  Valois  king,  followed  his 
brother  Charles.  With  Henry  also  Pare  had  many 
scenes.  One  fancies  the  great  surgeon  humoring 
and  chiding  the  effeminate,  debauched,  cruel, 
superstitious  wretch  who  now  sat  on  the  throne  of 
St.  Louis,  —  his  one  sane  and  able  companion  the 
court  jester,  Chicot,  as  Dumas  would  have  us 
believe. 

"Those  were  active  days,  —  terrible  days  in 
which  to  live,  —  gasping,  hectic,  vicious,  blood- 
spilling  days;  men  looking  about  wildly  for  relief 
and  direction;  women  turning  to  a  nebulous 
heaven,  whither  they  would  fain  be  led,  with  choice 
for  guides  of  libertine  priests  or  hard-fisted,  blood- 
stained Puritan  divines. 

"Pare  was  busy  among  them  all.    He  seems  to 


172  A  Doctor's  Table  Talk 

have  been  present  as  surgeon  with  the  royal  gar- 
rison of  Cahors  when  Henry  of  Navarre  made  his 
successful  attack  on  that  devoted  town.  It  was 
Navarre's  first  taste  of  war.  Chicot,  the  court 
jester,  unwillingly  was  in  his  suite.  The  great 
novelist  tells  his  story :  — 

"'At  this  moment,  as  if  in  response  to  the  imag- 
ination of  Chicot,  the  cannon  of  the  fortifications 
thundered,  and  opened  a  lane  through  the  infantry 
within  ten  paces  of  the  king  [of  Navarre].  "  Ventre 
Saint  Gris!"  he  said,  "did  you  see,  Chicot?  It  is 
all  for  the  best,  I  think,"  and  his  teeth  chattered. 
"He  is  going  to  be  ill,"  said  Chicot.  "Ah,"  mur- 
mured Henry,  "ah,  you  are  afraid,  cursed  carcass; 
you  tremble;  wait,  wait  a  moment;  I  will  make  you 
shake  for  something";  and  burying  his  spurs  in  the 
flanks  of  the  white  horse  that  carried  him,  he  rushed 
onward  before  the  troops.' 

"Cahors  fell.  Pare  and  Chicot  returned  with 
the  news  to  the  imbecile  king  in  Paris. 

"The  French  people  and  the  land  which  Pare 
loved  suffered  the  extreme  of  misery  through  all 
these  times.  The  broad  valleys,  the  rich  plains, 
and  the  vine-clad  hills,  such  as  we  know  them  to- 
day, were  harried  and  devastated. 


Reflections  —  Ambrose  Pare  173 

"Foreign  wars  with  Spain,  Italy,  and  Germany- 
followed  close  one  on  another.  The  new  religion 
and  the  old  were  in  continual  conflict.  In  1574,  on 
the  accession  of  Henry  III,  it  is  estimated  that 
*  already  by  reason  of  the  civil  wars  more  than  a 
million  persons  had  been  put  to  death,  all  under 
the  pretext  of  religion  and  public  utility,  with 
which  both  parties  shielded  themselves.'  Public 
executions  took  place  daily  in  all  parts  of  France. 
Private  murders  were  still  more  frequent.  The 
nobility  were  becoming  debased  or  extinguished; 
the  peasantry  were  starved  or  driven  from  the  plow 
to  the  battle-field;  the  middle  class  sat  quaking 
and  making  spasmodic  efi^orts  to  assert  itself 
through  the  States-General;  towns  were  razed, 
chateaux  were  burned,  and  the  worst  scenes  of 
ancient  Rome  were  reenacted.  The  most  gracious 
and  romantic  country  of  Europe  was  staggering 
in  a  slough  of  misery  and  contempt,  while  across 
the  Channel  England  was  living  the  splendid  days 
of  Elizabeth,  and  continental  Europe  was  falling 
under  the  powerful  sway  of  Charles  V  and  of  his 
dark  and  vicious  son  Philip. 

"In  the  midst  of  these  cruel  years  science  and 
the  arts  of  medicine  and  surgery  were  beginning 


174  ^  Doctor's  Table  Talk 

again  to  take  on  life.  Suffice  it  now  to  mention  a 
few  conspicuous  names  of  Fare's  period:  Andreas 
Vesalius,  of  Padua,  his  contemporary,  restored 
anatomy,  —  Vesalius,  one  of  those  remarkable 
youths  whom  history  betimes  records,  wise,  pro- 
phetic, daring;  Paracelsus,  charlatan  or  seer,  bom- 
bastic and  brilliant,  taught  his  disciples  to  look 
beyond  tradition  and  the  authority  of  a  dead  lan- 
guage; Malpighi  showed  that  the  organs  of  the 
body  are  not  homogeneous,  but  are  composed  of 
cells,  themselves  distinct  entities;  Servetus  per- 
ceived something  of  the  circulation  of  the  blood, 
and  was  burned  by  the  Protestants;  Eustachius 
contributed  to  human  anatomy;  Linacre  founded 
the  Royal  College  of  Physicians  in  London;  while 
Sylvius,  in  Paris,  gathered  up,  compiled,  and  sys- 
tematized the  fragments  of  former  knowledge. 

"One  observes  such  scattered  facts,  not  because 
they  matter  much  now  to  us,  or  greatly  concerned 
Pare,  but  because  they  recall  for  us  the  best  types 
of  scientific  men  who  were  then  beginning  to  think. 
For  the  mass  of  physicians  and  surgeons  in  the 
sixteenth  century  we  can  say  little  of  good.  They 
lived  according  to  their  dreary  lights,  and  practiced 
monstrously.  Ignorant  of  anatomy,  of  physiology, 


Reflections  —  Ambrose  Pare  175 

and  of  the  causes  and  nature  of  disease,  they  sub- 
stituted a  pathetic  traditional  empiricism  for  com- 
mon sense,  and  did  what  harm  they  could.  The 
Indian  savage,  with  his  incantations,  and  the  Tar- 
tar nomad,  with  his  primitive  massage,  were  in 
better  case  than  our  sixteenth-century  ancestors 
of  semi-civilized  Europe. 

"In  Fare's  time  medical  practice  had  been  in 
some  sort  systematized,  with  its  rules  and  its  pro- 
fessors. There  were  three  orders  of  practitioners, 
physicians,  surgeons,  and  barber-surgeons,  of 
whom  the  writers  tell,  each  with  their  peculiar 
traditions,  rights,  and  methods;  each  with  their 
shortcomings  and  characteristic  absurdities.  The 
physicians  stood  at  the  top.  They  must  talk  Latin, 
must  have  studied  in  recognized  schools,  and  have 
passed  rigid  tests  in  the  pedantry  of  the  times. 
They  inherited  many  of  the  traditions  of  the  priests, 
their  predecessors,  and  were  looked  to  as  the  guard- 
ians of  their  art.  They  determined  the  disease  of 
afflicted  patients  and  prescribed  the  treatment. 
On  no  pretext  must  they  soil  themselves,  or  debase 
their  calling,  by  the  shedding  of  blood.  Next  to 
the  physicians  came  the  surgeons  proper,  of  the 
confraternity  of  Saint  Cosmo,  surgeons  of  the  long 


176  A  Doctor's  Table  Talk 

robe,  as  they  were  called.  They,  too,  were  to  an 
extent  educated  men,  speaking  Latin,  passing 
examinations  in  Latin;  acting  as  humble  colleagues 
to  the  physicians,  performing  serious  surgical 
operations  in  civil  practice,  but  not  permitted  to 
prescribe  medicine  for  general  disease.  Finally, 
there  were  the  barber-surgeons,  humble  fellows 
enough,  speaking  the  vernacular  only,  rudely 
trained  as  apprentices  in  the  shop,  the  hospital, 
and  on  the  battle-field,  —  themselves,  too,  follow- 
ing an  old-time  tradition  and  calling.  In  ancient 
days  they  were  servants  of  the  monasteries,  — 
lay  brothers,  gardeners,  footmen,  butlers,  and  bar- 
bers; busy  barbers,  for  they  shaved  the  crowns  of 
their  masters.  Their  further  duties  were  manifold ; 
to  shaving  they  added  the  simple  household  surg- 
ical arts  of  bleeding  and  poulticing.  On  such  lines 
and  in  later  times  the  barber-surgeon  practiced 
his  own  independent  business.  It  came  about  that 
the  victim  of  a  bleeding  was  taught  to  grasp  in  his 
hand  a  stout  pole,  to  stimulate  the  flow  of  blood 
from  the  arm;  the  blood  as  it  ran  would  often  stain 
the  pole.  About  the  blood-stained  pole  the  barber 
twisted  a  white  ribbon  and  hung  this  emblem  of  his 
trade  above  the  outer  door.  To-day  he  hangs  it  there. 


Reflections  —  Ambrose  Pare  177 

"Pare  began  his  active  life  a  humble  barber- 
surgeon.  In  his  time,  physicians,  surgeons,  and 
barber-surgeons  were  continually  in  strife,  —  sur- 
geons poaching  upon  the  preserves  of  physicians, 
barber-surgeons  upon  those  of  surgeons,  and  all 
three  calling  upon  the  courts  and  the  king  to 
support  them  in  their  struggles  and  pretensions. 
Those  were  bitter  days;  union  labor  was  strongly 
organized,  and  the  struggle  for  existence  was  never 
more  fierce.  Such  were  the  men,  the  wrangles,  and 
the  times  into  which  Ambrose  Pare  was  born,  in 
the  year  of  Our  Lord  15 10,  Louis  XII  reigning  over 
France. 

"  France  was  then  at  war  in  Italy  —  a  war  mem- 
orable to  us  because  it  saw  the  death  of  Bayard. 
These  matters  did  not  immediately  concern  the 
family  of  the  child  Pare.  His  native  place  was  a 
hamlet  close  to  Laval  in  Maine.  His  father  was  a 
servant,  probably  valet  and  barber,  to  the  Seigneur 
de  Laval.  There  were  other  children  of  whom  the 
writers  tell;  a  sister  Catherine,  who  married  Gas- 
pard  Martin,  a  master  barber-surgeon  of  Paris, 
and  two  brothers  of  no  special  moment.  The  boy 
grew  up  in  humble  village  surroundings,  but  had 
the  unusual  privilege  for  that  day  of  learning  to 


178  A  Doctor's  Table  Talk 

read  and  write,  and  perhaps  some  slight  tincture 
of  the  Latin  —  though  he  seems  to  have  lost  that 
later.  We  find  him  next  in  Paris,  a  young  man  of 
twenty-three,  attending  lectures  on  anatomy  at 
the  iJniversity,  having  served  an  apprenticeship 
to  a  barber-surgeon,  name  unknown.  The  training 
was  hard  and  crude  enough,  —  long  hours,  con- 
stant work,  little  leisure,  and  blows  for  recompense. 
The  lectures,  too,  must  have  been  a  sorry  farce,  for 
besides  anatomy,  the  teacher  expounded  the  writ- 
ings of  De  Chauliac  on  wounds,  tumors,  and  ulcers, 
with  a  few  remarks  on  fractures  and  dislocations. 
*The  honor  of  the  University  forbade  a  professor 
to  speak  French,  and  the  apprentices  did  not 
understand  Latin'  (Paget). 

"By  this  time  the  old  King  Louis  XII  was  eight- 
een years  dead,  and  his  cousin,  Francis  I,  married 
to  Louis's  daughter  Claudia,  was  on  the  throne. 
It  was  a  reign  of  many  wars,  furnishing  abundant 
practice  for  the  budding  surgeon. 

"This  early  portion  of  Fare's  life  was  constantly 
busy  and  constantly  progressive.  He  was  a  keen, 
ambitious,  highly  intelligent  man;  kindly,  affec- 
tionate, generous;  undismayed  by  great  names 
and  pomposities;  familiar  early  with  human  weak- 


Reflections  — Ambrose  Pare  179 

ness  and  sorrow;  sympathetic  alike  with  the  suffer- 
ings of  peasant  and  priest,  fierce  men  and  frail 
women,  merchant,  magistrate,  and  monarch. 
While  still  unlicensed  to  practice,  he  won  an 
interneship  at  the  famous  Hotel  Dieu,  a  hospital 
already  nine  hundred  years  old;  the  refuge  of 
penniless  affliction,  the  abode  of  misery,  filth, 
nameless  abominations,  and  some  good  surgery. 
One  might  fill  pages  with  the  description  of  this 
marvelous  asylum,  where  men  and  women,  boys 
and  girls,  the  dead  and  the  living,  thieves  and  their 
victims,  leper§  and  infants  with  their  young  mothers, 
the  wounded,  the  insane,  and  the  plague-stricken 
were  herded  promiscuously  together,  often  three 
or  four  In  a  bed;  In  great  wards,  where  privacy 
was  impossible  and  decency  was  unknown,  where 
fierce  and  brutal  operations,  without  anaesthesia, 
were  done  at  the  bedside,  and  the  gigantic  washing 
of  foul  linen  was  accomplished  in  the  near-by  Seine 
but  twice  in  a  twelvemonth.  Such  was  Fare's 
home  for  nigh  three  years,  and  there  he  learned  to 
know  and  serve  his  kind. 

"The  year  In  which  Pare  left  the  Hotel  Dieu  was 
1537,  and  he  was  twenty-seven  years  old,  suffi- 
ciently skilled  in  his  profession  and  ready  to  begin 


i8o  A  Doctor's  Table  Talk 

the  business  of  life.  He  had  good  health,  common 
sense,  and  a  broad  outlook  on  the  future.  He  was 
content  with  no  paltry  corner  practice  and  the 
humdrum  good  will  of  simple  neighbors.  Immedi- 
ately he  established  a  snug  surgery  in  Paris,  and 
then  he  went  off  to  follow  his  profession  with  the 
army.  This  double  and  hazardous  course  he  took 
that  he  might  extend  his  activities,  increase  his 
acquaintance,  and  never  lack  occupation,  whether 
in  time  of  peace  or  war. 

"The  second  of  the  three  chapters  of  Fare's  life 
begins  with  this  year  1537  —  the  chapter  of  war 
and  adventure.  Not  until  1569,  after  more  than 
thirty  years,  did  he  settle  down  finally  to  a  civilian 
practice  in  Paris,  and  to  the  duties  and  employ- 
ments incident  to  his  dignity  and  advancing  years. 

"Pare's  military  life  furnishes  the  material  for 
one  of  the  most  picturesque  and  stimulating  sur- 
gical memoirs  in  literature.  It  was  written  after 
many  years,  and  in  the  author's  old  age.  In  it  he 
tells  us  much  of  the  story  of  his  life.  When  Pare 
was  seventy  years  old  there  ruminated  in  Paris  one 
Etienne  Gourmelen,  dean  of  the  faculty  of  medi- 
cine, —  a  devotee  of  the  easy-chair,  a  dyspep- 
tic, unpractical,  controversial  person.   This  dean 


Reflections  —  Ambrose  Pare  1 8 1 

attacked  the  great  surgeon  in  an  inane  book, 
which  opposed  ancient  authority  to  certain  of  the 
new,  brilliant,  and  effective  surgical  measures 
introduced  by  Pare.  Pare  answered,  told  much  of 
the  story  of  his  life  and  achievements,  in  a  series 
of  short,  trenchant  essays,  and  incidentally  crushed 
Gourmelen,  whom  he  contemptuously  addresses 
throughout  as  Man  petit  Maistre.  Pare  was  a 
master  of  clinical  surgeons.  Listen  to  his  opening 
paragraphs.  He  begins  without  preamble:  'I  will 
here  show  my  readers  the  towns  and  places  where 
I  found  a  way  to  learn  the  art  of  surgery.  ...  In 
the  year  1536  the  great  King  Francis  sent  a  large 
army  to  Turin.  .  .  .  M.  de  Montejan  was  Colonel- 
General  of  the  infantry,  whose  surgeon  I  was  at 
this  time.'  Observe  that  officers  took  with  them 
their  own  personal  surgeons.  There  was  then  no 
regular,  organized  army  medical  corps. 

"'A  great  part  of  the  army  being  come  to  the 
pass  of  Suze,  we  found  the  enemy  occupying  it, 
and  they  had  made  forts  and  trenches,  so  that  we 
had  to  fight  to  dislodge  them  and  drive  them  out. 
And  there  were  many  killed  and  wounded  on  both 
sides.  .  .  .  Now  I  was  at  this  time  a  fresh-water 
soldier;  I  had  not  yet  seen  wounds  made  by  gun- 


1 82  A  Doctor'' s  Table  Talk 

shot,  at  the  first  dressing.  It  is  true  I  had  read  in 
John  de  Vigo  that  wounds  made  by  fire-arms  par- 
take of  venenosity;  and  for  their  cure  he  bids  you 
cauterize  them  with  oil  of  elders  scalding  hot, 
mixed  with  a  little  treacle.  And  to  make  no  mis- 
take, before  I  would  use  the  said  oil,  knowing  this 
was  to  bring  great  pain  to  the  patient,  I  asked  first, 
before  I  applied  it,  what  the  other  surgeons  did  for 
the  first  dressing,  which  was  to  put  the  said  oil, 
boiling  well,  into  the  wounds,  wherefore  I  took 
courage  to  do  as  they  did.  At  last  my  oil  ran 
short,  and  I  was  forced,  instead  thereof,  to  apply 
the  yolks  of  eggs,  oil  of  roses,  and  turpentine.  In 
the  night  I  could  not  sleep  in  quiet,  fearing  some 
default  in  not  cauterizing,  that  I  should  find  the 
wounded  to  whom  I  had  not  used  the  said  oil  dead 
from  the  poison  of  their  wounds,  which  made  me 
rise  very  early  to  visit  them;  when  beyond  my 
expectation  I  found  that  those  to  whom  I  had 
applied  my  digestive  medicament  had  but  little 
pain,  and  their  wounds  without  inflammation  or 
swelling,  having  rested  fairly  well  that  night;  the 
others,  to  whom  the  boiling  oil  was  used,  I  found 
feverish,  with  great  pain  and  swelling  about  the 
edges  of  their  wounds.  Then  I  resolved  never  more 


Reflections  —  Ambrose  Pare  1 83 

thus  cruelly  to  burn  poor  men  with  gunshot 
wounds.' 

"That  anecdote  —  the  trying  experience  and 
the  sane  conclusion  —  are  characteristic  of  Pare. 
He  drew  his  own  conclusions,  and  acted  on  convic- 
tion, and  in  that  he  differed  from  all  practitioners 
of  his  time.  He  dared  greatly,  for  he  lived  in  an  age 
of  conservative  authority.  Those  fine,  humane,  and 
rational  qualities  made  him  one  of  the  foremost 
clinical  surgeons  in  our  annals.  And  regarding  this 
particular  story  of  the  boiling  oil,  so  modestly  told, 
let  us  observe  this :  that  the  simplified  wound  treat- 
ment for  gunshot  Injuries,  then  introduced,  was 
one  of  Fare's  great  contributions  to  surgery  — 
perhaps  his  greatest.  After  Pare,  torturing  of  the 
wounded  put  men  In  111  repute.  So  let  us  note,  as 
his  first  important  contribution  to  surgery,  the 
simplified  treatment  of  gunshot  wounds. 

"  Pare's  memoirs  are  full  of  strange  tales,  one  of 
which  suggests  the  famous  Harvard  crowbar  case — 
in  which  a  quarryman  recovered  after  a  tamplng- 
iron  had  passed  completely  through  his  head  from 
beneath  the  chin  upwards,  emerging  at  the  vertex. 
Pare  tells  us  how  Francis  of  Lorraine,  Duke  of 
Guise,    was    wounded    before    Boulogne   with   a 


i84  A  Doctor's  Table  Talk 

thrust  of  a  lance,  *  which  entered  above  the  right 
eye,  towards  the  nose,  and  passed  out  on  the  other 
side  between  the  ear  and  the  back  of  the  neck,  with 
so  great  violence  that  the  head  of  the  lance,  with  a 
piece  of  wood,  was  broken  and  remained  fast;  so 
that  it  could  not  be  drawn  out  save  with  extreme 
force  with  smith's  pincers.  Yet,  notwithstanding 
the  violence  of  the  blow,  which  was  not  without 
fracture  of  bones,  nerves,  veins,  and  arteries,  and 
other  parts  torn  and  broken,  my  lord,  by  the  grace 
of  God,  was  healed.' 

"Casual  students  of  surgical  literature  think  of 
Pare  as  the  man  who  invented  the  ligature  of  arter- 
ies, and  doubtless  we  recall  the  celebrated  paint- 
ing, many  times  reproduced,  of  the  great  surgeon 
on  the  battle-field,  surrounded  by  prancing  horses, 
stately  pavilions,  and  pompous-looking  officers, 
as  he  amputates  the  leg  of  an  anxious  soldier,  who 
sits  stroking  his  long  beard  and  gazing  at  the  stump, 
while  Pare  waves  aside  the  hissing  cautery  and 
applies  a  linen  ligature  to  the  bleeding  artery.  It  is 
a  striking  scene.  Here  is  Pare's  modest  account  of 
the  great  achievement:  'On  his  return  from  the 
expedition  King  Henry  [H]  besieged  Danvilliers, 
and  those  within  would  not  surrender.   They  got 


Reflections  —  Ambrose  Pare  185 

the  worst  of  it,  but  our  powder  failed  us;  so  they 
had  a  good  shot  at  our  men.  There  was  a  culverin- 
shot  passed  through  the  tent  of  M.  de  Rohan,  which 
hit  a  gentleman's  leg,  who  was  of  his  household. 
I  had  to  finish  the  cutting-off  of  it,  which  I  did 
without  applying  the  hot  irons.'  He  tied  the  bleed- 
ing vessels  with  linen  threads,  and  so,  without 
needless  pain,  he  saved  the  life  of  the  man,  who 
exclaimed  that  he  had  got  clear  of  his  leg  on  very 
good  terms. 

"In  truth,  however.  Pare  never  dreamed  of 
claiming  that  he  had  invented  the  ligature.  The 
ligature  was  used  by  Roman  Galen  and  many  oth- 
ers in  ancient  times  to  control  hemorrhage  from 
wounds;  but  strangely  enough,  the  thought  of 
controlling  hemorrhage  from  amputation  wounds 
seems  to  have  occurred  to  none  until  Pare  in  the 
middle  of  the  sixteenth  century. 

"That  was  a  notable  feat.  It  marked  an  era  in 
surgical  history.  Taken  with  the  simplified  method 
of  wound  treatment,  it  inaugurated  a  new  concep- 
tion of  surgery,  —  of  an  art  hitherto  barbarous  and 
cruel,  now  become  beneficent  and  humane.  In  a 
hundred  other  ways  Pare  showed  his  kindness  of 
heart  and  an  understanding  of  how  human  suffer- 


i86  A  Doctor's  Table  Talk 

ing  might  be  lessened,  until  his  sensibilities  bore 
the  stamp  of  genius.  He  learned  to  go  about  his 
work  deftly,  silently,  effectively.  He  quieted  terror; 
he  soothed  pain;  he  encouraged  sleep;  he  appreci- 
ated the  value  and  limitations  of  food  and  stimu- 
lants, of  clean  air  and  fresh  linen.  His  splints  and 
dressings  were  a  revelation  in  comfort  and  support. 
His  bandaging  was  a  marvel  of  smoothness,  beauty, 
and  efficiency.  Henry  H  felt  that  he  could  die 
under  his  care  in  dignity  and  ease.  Francis  H,  in 
his  last  hours,  held  the  kind  hand  of  his  benefactor. 
Antoine,  King  of  Navarre,  resigned  himself  to 
death  when  Pare  whispered  that  his  torn  shoulder- 
joint  would  prove  fatal;  and  Charles  IX  clung  to 
him  through  his  final,  shrieking,  ghost-haunted 
days.  Ambrose  Pare  was  a  great  soul,  truly  with- 
out fear  and  without  reproach. 

"Let  us  look  again  at  some  of  the  facts  and  de- 
tails of  his  career.  We  saw  him  oif  for  the  wars  in 
Italy,  when  Francis  I  was  fighting,  when  the  cen- 
tury was  still  young,  and  himself  in  his  twenty- 
eighth  year.  So  well  did  he  conduct  himself  that  he 
rose  shortly  above  the  crowd,  for  he  qualified  as  a 
master  barber-surgeon  at  thirty-one.  Later,  after 
sixteen  years  of  military  life,  he  had  so  won  the 


Reflections — Ambrose  Pare  ■  187 

confidence  of  kings  and  their  officers,  and  had  so 
endeared  himself  to  the  common  soldiers,  that  his 
presence  alone  was  looked  on  as  better  than  a  rein- 
forcement. When  Metz  was  besieged  by  the  Span- 
iards in  1552,  Pare,  sent  by  King  Henry,  penetrated 
to  the  city.  Guise  commanded  the  defense.  He 
embraced  the  great  surgeon,  presented  him  to  his 
delighted  officers,  and  revived  the  spirits  of  his 
broken  troops,  who  cheered  him  wildly,  shouting 
that  now  they  should  not  die,  since  Ambrose  Pare 
was  come.  The  city  was  saved. 

"We  remember  the  surgeons  of  the  long-robe, 
that  proud  little  brotherhood  of  Saint  Cosmo, 
who  patronized  and  scorned  the  barber-surgeons. 
They  saw  the  rise  of  Pare,  appreciated  his  distinc- 
tion, and  resolved  to  make  him  their  own.  So,  with- 
out formality,  with  scarcely  the  pretense  of  an 
examination,  their  precious  Latin  forgotten,  they 
admitted  him  to  their  ranks  and  made  him  their 
most  honored  member. 

"  In  the  intervals  of  these  skirmishings,  rewards, 
and  military  honors.  Pare  was  employing  himself 
as  a  civil  surgeon  of  distinction.  His  casting-forth 
of  the  boiling  oil  had  early  attracted  the  interest 
of  the  great  Sylvius,  now  an  old  man,  and  his  former 


i88  A  Doctor's  Table  Talk 

master;  and  the  friendship  of  Sylvius  helped  his 
struggling  youth.  He  returned  often  to  Paris;  his 
military  fame  introduced  him  to  powerful  patrons, 
and  kings  honored  him,  as  we  have  seen.  He  mar- 
ried —  Jehanne  Mazelin  —  whose  father  was  a 
servant  of  the  great  Du  Prat,  Chancellor  of  France. 
Pare  took  her  with  one  hundred  and  twenty  dol- 
lars for  dot;  she  was  twenty  and  he  was  thirty-one. 
They  had  a  daughter,  but  no  son  lived  to  maturity. 
Years  later,  when  past  middle-age  and  after  the 
death  of  Jehanne,  Pare  married  again;  this  time 
with  many  marriage  settlements  and  much  stately 
display.  But  though  he  became  the  father  of  nine 
children  in  all,  he  had  the  fate  of  most  great  men; 
no  children  lived  to  carry  down  his  name. 

"Of  Pare  we  recall  another  fact,  too,  — a  fact  in- 
evitable in  the  life  of  a  distinguished  surgeon,  —  he 
was  a  great  writer  and  teacher.  He  was  a  keen  and 
unsparing  controversialist;  he  was  a  born  leader  of 
men.  Much  of  his  writing  was  final  for  centuries. 
He  had  been  publishing  essays  and  treatises  through 
all  his  professional  life  —  mostly  on  matters  deal- 
ing with  military  surgery;  but  in  1575,  when  sixty- 
five  years  old,  he  issued  an  edition  of  his  collected 
works,  dedicated  to  that  absurd  king,  Henry  HI: 


Reflections  —  Ambrose  Pare  189 

*God  is  my  witness,'  he  writes,  'and  men  are  not 
ignorant  of  it,  that  I  have  labored  more  than  forty 
years  to  throw  light  on  the  art  of  Surgery  and  bring 
it  to  perfection.  And  in  this  labor  I  have  striven  so 
hard  to  attain  my  end  that  the  ancients  have  naught 
wherein  to  excel  us,  save  in  the  discovery  of  first 
principles;  and  posterity  will  not  be  able  to  surpass 
us  (be  it  said  without  malice  or  offense)  save  by 
some  additions,  such  as  are  easily  made  to  things 
already  discovered.' 

"It  would  be  profitless  here  to  discuss  in  detail 
those  surgical  accomplishments  which  brought  him 
pride.  Of  his  methods  and  his  attitude  towards 
suflPering  I  have  already  spoken.  He  was  an  en- 
cyclopaedic writer.  As  Paget  remarks:  *Save  Art 
and  Politics,  the  works  of  Pare  contain  every  possi- 
ble subject:  Anatomy  and  Physiology,  Medicine, 
Surgery,  Obstetrics,  State  Medicine,  Pathology, 
Pharmacy,  Natural  History,  Demonology,  and 
much  else.'  He  dealt,  as  an  authority,  with  all 
these  matters :  he  had  the  short-comings  of  his  time, 
to  be  sure,  —  something  of  credulity,  no  little  of 
superstition,  dread  of  unseen  and  malign  influences; 
but  when  all  is  said,  he  recognized  in  the  main  the 
healing  forces  of  nature  and  the  preponderance  of 


190  A  Doctors  Table  Talk 

good,  even  in  that  blood-stained  age;  the  value  of 
solid  accomplishment,  the  saving  grace  of  work, 
and  all  with  the  simplicity  and  enthusiasm  of  a 
truly  great  soul.  His  enormous  experience  lends 
force  to  his  descriptions,  conclusions,  and  advice; 
we  rise  from  the  reading  convinced  that  here  indeed 
was  a  man. 

"  Such  writings,  activities,  and  labors  kept  Pare 
continually  in  the  public  eye.  While  he  won  and 
held  the  regard  of  kings  and  peasants,  he  was 
not  always  in  favor  with  conventional  physicians. 
While  he  labored  for  the  dignity  and  advancement 
of  his  own  order,  he  met  the  jealousy,  dislike,  and 
opposition  of  university  authorities.  In  the  end  he 
prevailed  largely.  That  is  a  long  story,  —  signifi- 
cant to  Dryasdust,  valueless  to  us. 

"Tradition  has  reckoned  Ambrose  Pare  a  Hugue- 
not, but  that  is  a  matter  on  which  he  himself  mainly 
is  silent.  The  friend  of  Coligny,  the  correspond- 
ent of  Calvin,  the  surgeon  and  friend  of  Guise, 
the  confidant  of  Charles  IX  and  Henry  III,  —  it  is 
impossible  to  class  Pare  among  the  partisans  of  a 
creed.  He  went  to  mass;  he  read  the  Bible;  he 
respected  the  Church  of  Rome;  he  lived  in  charity 
with  Protestant  divines :  not  that  he  was  all  things 


Reflections  —  Ambrose  Pare  191 

to  all  men,  but  he  looked  for  the  best  in  all,  and 
endured  sadly  the  shouting  of  sectaries,  the  pre- 
tension of  dogma,  and  the  exalting  of  fugacious 
gabble.  Whatever  he  believed,  —  peace  to  his 
ashes,  —  I  doubt  if  he  had  a  creed.  But  he  lived 
through  the  St.  Bartholomew  —  a  bitter  day,  never 
to  be  forgotten,  August  24,  1 572.  Two  days  before 
the  massacre  the  Huguenot  hero,  Coligny,  Admiral 
of  France,  was  shot  at,  while  leaving  the  king's 
palace.  His  hand  only  was  injured,  and  he  sent  for 
his  friend  Pare  to  repair  the  damage.  Pare  ampu- 
tated two  fingers,  but  he  had  come  in  haste,  im- 
properly equipped.  The  work  was  roughly  done, 
but  Coligny  never  flinched.  Rumors  were  in  the  air; 
anxiety  was  abroad;  the  king  in  his  palace  was 
reserved  and  morose;  the  villainous  queen  mother, 
Catherine  de'  Medici,  was  conspiring;  young 
Henry  of  Navarre  —  half  prisoner,  half  guest  — 
was  being  married  to  the  king's  sister.  Marguerite 
de  Valois;  unwonted  crowds,  with  strange  tokens 
and  passwords,  roamed  the  streets.  Pare  went 
unharmed  among  them  all.  We  hear  of  him  in  the 
king's  chamber;  we  watch  him  accosted  by  Guise; 
we  see  him  at  the  sick-bed  of  Coligny.  Early  in 
the  morning  of  the  twenty-fourth,  Sunday,  one  of 


192  A  Doctor's  Table  Talk 

Collgny's  gentlemen,  Cornaton,  hurries  in.  *Mon- 
seigneur,'  he  cries, 'It  Is  God  who  calls  us  to  Him.* 
CoIIgny  replies,  *  I  have  been  ready  to  die  this  long 
time,  but  you,  my  friends,  save  yourselves  If  you 
still  can.'  They  escaped  over  the  roof,  Ambrose 
Pare  carried  with  them;  and  later,  by  the  king's 
order,  he  was  secreted  In  the  royal  chamber  from 
the  assassins.  We  read  of  the  old  Admiral  stabbed 
in  his  bed,  cast  out  into  the  courtyard,  and  there 
dispatched  by  order  of  Guise,  director  of  the  day's 
work. 

"The  last  chapter  of  Fare's  life  runs  with  the 
reign  of  the  last  Valois  king,  Henry  HI,  —  from 
1574  to  1589.  Pare  himself  died  in  1590,  in  his 
eighty-first  year.  While  those  last  sixteen  troubled 
years  were  given  largely  to  his  country,  Pare  never 
for  a  day  forgot  the  advancement  of  his  own  pro- 
fession. He  worked.  The  sum  total  of  his  labors  is 
astounding.  He  wrote;  he  spoke;  he  traveled.  He 
was  seventy-five  years  old  when  he  published  the 
famous  'Journeys,'  in  reply  to  Gourmelen.  A 
few  years  before  this  we  find  him  putting  out  two 
great  surgical  volumes  of  five  hundred  pages  each. 
One  groans  over  his  daily  routine.  He  rose  at  four 
in  the  morning,  and  went  at  once  to  his  surgery. 


Reflections — Ambrose  Pare  193 

where  he  read  and  wrote  until  six;  then  he  break- 
fasted on  milk  and  dry  bread.  At  six-thirty  he 
began  the  reception  of  patients,  who  thronged  to 
him  until  eleven  o'clock,  when  he  dined.  After 
dinner  he  slept  for  a  half-hour,  when  he  started 
forth  on  his  rounds,  on  foot  or  horseback,  —  sur- 
geons had  no  carriages  in  those  days.  Often  he 
visited  the  Hotel  Dieu,  where  he  operated  and 
taught,  and  where  he  wrote  over  the  door:  'I  dress 
the  wound;  God  heals  it.'  He  supped  wherever 
chance  found  him,  —  in  some  humble  shop,  at  the 
hospital,  the  Louvre,  or  rarely  with  his  wife  at 
home;  then  to  his  studies  again,  or  to  see  more 
patients,  and  at  last  to  bed,  at  midnight  or  long 
after. 

"  He  was  always  well.  Born  in  the  country,  and 
of  a  vigorous  stock,  he  grew  up  a  vigorous  lad,  and 
rarely  himself  knew  what  sickness  was.  Simple  and 
abstemious,  his  forces  never  failed,  and  he  met  his 
work  as  it  came.  Once  he  broke  his  leg;  once  he  was 
bitten  by  a  poisonous  reptile;  once  he  had  a  hemor- 
rhage; and  again  a  sharp  sciatica  from  exposure 
and  overwork;  but  he  rallied  with  vigor  unimpaired. 
Once  he  fainted,  standing  over  a  plague-stricken 
patient;  he  had  the  plague  himself  later,  but  it 


194  ^  Doctor's  Table  Talk 

mattered  not.  He  was  abstemious,  though  he 
loved  good  wine,  and  it  is  surmised  (Paget)  that 
he  never  smoked,  for  he  was  fifty  when  Jean  Nicot 
brought  the  first  tobacco  to  Paris.  Once  he  believed 
that  his  enemies  tried  to  poison  him.  It  was  at 
Rouen  in  1562,  and  he  writes:  'I  found  myself  at 
dinner  with  a  company,  wherein  were  some  who 
hated  me  to  death  for  the  Religion.  They  handed 
me  some  cabbages,  which  contained  either  corro- 
sive sublimate  or  arsenic.  With  the  first  mouthful 
I  felt  nothing;  with  the  second,  I  had  a  great  heat 
and  burning,  and  great  astringency  in  the  mouth, 
and  especially  at  the  back  of  it,  and  the  foul  taste 
of  the  good  drug.' .  .  .  Loyal  man;  at  any  rate,  he 
took  the  proper  remedy  and  it  worked. 

"The  writers,  and  especially  his  voluminous 
biographer,  Malgaigne,  tell  many  stories  character- 
istic of  Pare.  In  spite  of  his  goodness  of  heart,  he 
hated  beggars,  for  the  beggars  of  old  Paris  were  a 
mighty  army  of  rogues,  thieves,  and  impostors, 
such  as  Victor  Hugo  scores:  'There  was  the  woman 
whom  Jehanne  Pare  found  begging  at  the  door  of 
the  Huguenot  Chapel  at  Vitry,  on  a  Sunday,  with 
a  counterfeit  ulcer,  and  so  she  was  whipped  and 
banished.'  There  was  another  beggar,  with  banner 


Reflections  —  Ambrose  Pare  195 

and  tub  and  castinets;  his  face  was  covered  with 
leprosy  made  of  glue,  and  was  kept  of  a  livid  tint 
by  a  scarf  pulled  round  his  neck,  half  throttling 
him.  He,  too,  was  unmasked,  and  was  whipped 
thrice  through  the  town,  and  the  third  whipping 
killed  him,  while  the  gossips  told  how  it  was  no 
great  loss  to  the  country. 

"In  those  last  years  of  his  life,  when  the  royal 
house  was  tottering,  when  the  Guises  and  a  few 
great  nobles  endeavored  to  control  the  king,  when 
the  country  was  rent  by  religious  wars,  and  Hugue- 
not Henry  of  Navarre,  opposing  the  Catholic 
League,  was  advancing  across  the  land,  Pare  con- 
tinued in  Paris,  busy  with  his  peaceful  art.  That 
was  a  distraught  and  unhappy  Paris,  set  in  the  midst 
of  an  unhappy  France.  Two  hundred  years  later 
we  read  of  the  Reign  of  Terror,  and  the  downfall 
of  an  aristocracy,  the  great  ones  of  the  earth.  Un- 
happy France;  she  has  seen  many  reigns  of  terror, 
but  the  cruelty  of  Robespierre  and  of  Danton  was 
as  nothing  compared  to  the  cruelty  of  Catholic  and 
Huguenot,  Henry  of  Valois,  Henry  of  Navarre, 
and  Henry  of  Guise. 

"In  his  own  last  years  Fare's  Paris  was  a  place 
of  some  two  hundred  thousand  souls,  constantly 


196  A  Doctor^ s  Table  Talk 

increased  by  the  wretched  country  people  whom 
war,  devastation,  and  famine  drove  to  the  city. 
They  came  in,  —  haggard,  emaciated,  starving, 
diseased,  —  to  swell  the  increasing  swarms  of  beg- 
gars and  the  destitute.  The  sufferings  of  Paris  were 
indescribable,  and  Pare  was  a  familiar  figure  to  all 
these  people.  He  is  one  of  the  historic  figures  of 
the  Paris  of  those  awful  times,  —  as  it  is  written 
of  him,  'Known  to  everybody,  keeper  of  the  lives 
and  secrets  of  innumerable  important  people,  head 
of  his  profession,  chief  surgeon  to  the  king.'  The 
plague  came  in  1580,  and  remained  for  years,  as  if 
that  alone  were  wanting.  The  price  of  food  was 
prohibitive  except  for  the  rich.  Taxes  rose  mean- 
time, and  the  luxury  of  the  court  and  its  followers 
increased.  One  might  quote  scores  of  instances. 
Observe  one  from  L'Estoile's  Journal:  'August 
23, 1587,  Jean  Louis  de  Mougaret,  due  d'Espernon, 
chief  favorite  of  the  king,  whom  he  used  to  call  his 
eldest  son,  was  married  quietly  at  the  chateau  of 
Vincennes.  The  story  was  told  everywhere  that 
the  king  gave  him  on  his  marriage  the  sum  of  four 
hundred  thousand  crowns.' 

"And  again:  'Truly  the  face  of  Paris  was  miser- 
able at  this  time;  and  he  who  has  ever  heard  or 


Reflections  —  Ambrose  Pare  197 

read  in  Josephus  the  factions  of  John,  Simon,  and 
other  villains,  who  under  the  veil  of  hypocritical 
religious  zeal  plundered  and  sacked  the  city  of 
Jerusalem,  —  if  he  had  now  come  to  Paris,  he  would 
have  seen  a  like  thing/ 

"The  diary  of  the  years  goes  on  with  increasing 
gloom  and  despair.  The  king  becomes  more  craven, 
superstitious,  and  imbecile;  the  power  of  the 
Catholic  Guises  and  their  League  increases;  rioting 
and  anarchy  spread.  Pare  remains  at  his  post,  but 
his  fees  have  dwindled  away. 

"Great  national  and  international  events  are  re- 
corded: News  of  the  execution  of  Mary  Queen  of 
Scots  in  1587;  Navarre's  victory  of  Coudras  in  the 
same  year;  the  outbreak  of  fighting  between  the 
Guises  and  the  king  in  1588,  and  their  pretended 
reconciliation;  news  of  the  Spanish  Armada  de- 
stroyed; and  finally,  at  the  end  of  the  year,  the 
murder  of  Guise  and  of  his  brother  the  cardi- 
nal. With  the  incoming  of  another  year,  1589,  old 
Queen  Catherine,  the  King's  mother,  died,  and 
then,  six  months  later,  the  King  himself  was  assas- 
sinated. 

"All  this  availed  nothing  to  our  old  hero  Pare  and 
his  forlorn  people.  The  political  heirs  of  the  Guises 


198  A  Doctor^ s  Table  Talk 

kept  up  the  civil  war,  and  Henry  of  Navarre,  now 
Henry  IV,  laid  siege  to  distracted  Paris,  after  win- 
ning the  battle  of  Ivry  in  March,  1590. 

"  '  Through  thy  cornfields  green,  and  sunny  vines,  0  pleasant 
land  of  France.' 

"We  come  to  the  last  scenes  of  Ambrose  Pare. 
Henry  IV,  the  Huguenot  champion,  invested  Cath- 
olic Paris.  The  people  began  to  die  in  the  streets, 
-^  one  hundred  to  two  hundred  daily.  The  food 
came  to  an  end,  and  they  ate  the  dead.  The  Arch- 
bishop of  Lyons  led  the  defense,  while  the  priests 
put  on  armor  and  raged  through  the  city.  Here 
again  we  find  Pare.  Eighty  years  old,  heart-sick, 
exhausted,  and  indignant,  he  meets  the  great  pre- 
late in  the  streets.  Before  hundreds,  he  shows  him 
the  hopeless  situation  and  the  misery  of  his  flock, 
—  dead  and  dying  about  them,  —  and  implores 
him  to  put  an  end  to  the  useless  struggle.  A  few 
days  later  the  siege  was  raised. 

"This  last  awful  year  saw  the  end  of  Pare.  He 
died  in  December,  but  of  his  last  days  we  know  no 
more.  It  is  a  notable  and  important  life.  Perhaps 
it  was  a  great  life.  One  speculates  on  what  this  man 
might  have  done  had  he  lived  in  better  days  and 
saner  times.    But  such  speculation  is  profitless. 


Reflections  —  Ambrose  Pare  199 

The  times  helped  make  the  man.  We  see  him  a 
mighty  soul  when  men's  hearts  were  failing  them;  a 
brave  reformer,  a  good  citizen,  and  a  great  surgeon, 
when  chaos  reigned.  Some  men  are  great  for  having 
lived  unspotted  in  this  naughty  world.  It  was  so 
with  Pare.  The  people  of  France  loved  him  for 
what  he  was.  The  spirit  of  his  young  manhood 
never  left  him;  and  he  died  as  he  had  lived  —  a 
high-hearted  and  gallant  gentleman. 

"'So  nigh  is  grandeur  to  our  dust, 
So  near  is  God  to  man,  — 
When  Duty  whispers  low  —  "Thou  must," 
The  Youth  replies  —  "I  can." '" 


CHAPTER  IX 

Hospital  Talk 

As  we  journeyed  southward  a  day  or  two  later,  I 
found  Ely  unusually  silent.  The  beautiful  drive 
through  the  hills  passed  him  by  almost  unnoticed ; 
and  it  was  not  until  we  had  been  a  half-hour  in  the 
train  that  he  came  to  himself.  In  the  morning's 
paper  I  read  undigested  fragments  of  thought,  and 
other  slip-slop.  The  newspaper  world  seemed  triv- 
ial enough  after  the  little  world  of  earnest  fact  we 
had  left. 

Ely  took  up  the  tale:  "There  is  no  doubt  that 
Primrose  has  an  interesting  life;  perhaps  his 
method  is  better  than  ours.  In  his  writing  and  talk- 
ing about  illness,  too,  I  could  not  but  contrast  his 
thoughts,  and  his  point  of  view  with  those  of  aver- 
age patients.  He  suggested  that  contrast  himself 
when  he  wrote  about  their  frequent  puzzlement 
and  terror.  How  true  it  is  that  with  most  of  us  the 
final  scenes  are  undignified  and  commonplace  even 
among  the  highest  and  most  aloof  persons.  We 
doctors  seem  to  get  under  the  skins  of  all  mankind. 


Hospital  Talk  201 


I  remember  Arthur  Benson  puts  it  somewhat  dif- 
ferently. In  describing  the  last  hours  of  Charles 
Kingsley,  who  died  of  pneumonia,  Benson  writes 
something  of  this  sort,  —  'He  lay  unconscious,  in 
the  sad  and  solemn  occupation  known  as  dying — 
when  the  most  commonplace  person  in  the  world, 
who  lies  dozing  and  fevered  in  the  darkened  room, 
is  invested  for  all  who  move  silently  about  the  house 
with  a  strange  majesty  and  awe.'  Yet  that  descrip- 
tion does  not  necessarily  conflict  with  my  statement. 
For  the  doctor,  and  more  especially  for  the  nurse, 
—  for  those  of  us  who  are  occupied  with  the  humble 
personal  offices  about  the  sick  man,  —  it  is  all 
commonplace  enough;  while  for  the  anxious 
friends  and  children,  for  those  who  loiter  sadly 
near  the  accustomed  room,  in  unaccustomed  idle- 
ness, waiting  through  the  hours,  there  is  that 
strangeness  and  that  awe  of  which  Benson  tells. 
Sometimes  it  seems  as  though  the  waiting  were 
without  beginning  and  would  never  end.  Then 
unexpectedly,  gently,  a  whispered  voice  tells  us  it 
is  over;  and  we  look  about  surprised,  almost 
ofl"ended,  as  it  were,  by  something  past  belief. 

"Those  are   the  days   in  which   one  lives   at 
close  grips  with  the  unknown,  —  and  yet  that  un- 


202  A  Doctor's  Table  Talk 

known  should  some  day  be  knowable,  one  almost 
thinks. 

"Primrose's  little  description  of  the  ancient 
Hotel  Dieu  was  interesting.  The  fact  is,  in  that 
nasty,  unwashed  old  France,  the  great  hospital 
grew  worse  and  worse  until  after  the  French  Revo- 
lution. I  remember  reading  how  surprised  were  the 
French  medical  officers,  who  came  to  America  dur- 
ing our  own  Revolution,  when  they  saw  the  decency 
of  our  well-swept  wards  in  the  new  Philadelphia 
and  New  York  hospitals.  Of  course  all  hospitals, 
the  world  over,  shine  to-day  with  resplendent  pol- 
ish, but  I  fancy  the  sensations  of  modern  patients, 
when  they  enter  one  of  our  hospitals,  are  not  very 
different  from  the  sensations  of  their  great-grand- 
mothers. I  mean  our  large  municipal  hospitals  for 
the  poor. 

"Did  you  ever  try  to  put  yourself  in  the  place  of 
a  sensitive  sick  man  going  to  a  large  general  hos- 
pital 1  I  have,  and  I  've  come  to  see  that  the  expe- 
rience may  be  very  hard.  It  was  far  worse  be- 
fore we  had  the  help  of  Social  Service  workers. 
Of  course  all  these  trials  against  which  sensitive 
persons  protest  are  perhaps  inevitable;  but  cer- 
tainly a  sick  man  on  going  to  a  hospital  has  a  right 


Hospital  Talk  203 


to  demand  better  treatment  than  he  gets  from  the 
ticket-agents  and  gate-men  in  a  railway  station. 
Of  course,  too,  all  officials  who  deal  personally 
with  the  great  public  must  have  a  hard  time  of  it. 
Every  policeman  knows  that.  That  great  public 
is  rude,  boisterous,  and  uncivil  mostly,  —  on  the 
street,  on  its  travels,  and  at  baseball  games.  In 
such  places  it  needs  firm,  and  even  rough  handling. 
But  when  the  great  public  is  ill  and  goes  to  a  hos- 
pital, it  must  be  kindly  treated.  Then  it  is  fright- 
ened; it  is  in  pain;  it  has  fever;  it  is  mystified; 
it  Is  not  bossing  Its  own  job;  it  is  confiding  itself  to 
the  care  of  strangers,  whom  it  is  told  to  trust,  and 
it  feels  that  it  is  entering  blindly  upon  a  great, 
strange,  and  terrible  experience.  We  doctors,  in 
talking  to  a  poor  patient  in  our  offices,  and  when 
advising  his  going  to  a  general  hospital,  are  often 
unreasonably  impatient  and  Irritable  because  the 
patient  shrinks  from  the  prospect.  I  'm  afraid  we  're 
sometimes  bumptious  and  patronizing.  Our  point 
of  view  seems  often  to  be  that  we  alone  are  bestow- 
ing the  benefit,  —  a  mediaeval  and  absurd  notion. 
It  is  said  that  Mr.  Rockefeller  gave  a  great  sum  to 
help  medical  teaching  at  one  of  our  universities 
^because  he  was  convinced  that  that  university, 


204  A  Doctor* s  Table  Talk 

through  its  hospital  affiliations,  controlled  the  *  rich- 
est clinical  material'  to  be  found.  The  staff  posi- 
tions of  our  great  hospitals  —  even  those  that  pay 
nothing  whatever  in  dollars  —  are  sought  and 
held  through  active  life  by  our  most  ambitious 
men.  Every  patient  in  a  hospital,  every  sick  man, 
furnishes  material  for  laboratory  study.  Without 
the  sick  In  our  general  hospitals,  medical  progress 
would  be  almost  impossible,  or  would  stop;  and 
without  the  complacent  patient  for  his  demonstra- 
tions the  bedside  teacher  would  soon  resign  his 
chair.  These  are  facts  which  our  own  profession, 
as  well  as  the  general  public,  should  have  more 
constantly  in  mind.  I  wish  you  would  write  them 
down  and  put  them  in  a  book  some  time. 

"Another  thing,  —  as  long  as  I  am  lecturing  you, 
and  Primrose  has  turned  us  towards  medical  his- 
tory, we  must  remember  that  the  purpose  of  a  hos- 
pital is  quite  different — is  immensely  broader,  than 
it  was  a  hundred  years  ago.  Take  the  old  Penn- 
sylvania Hospital  in  Philadelphia,  for  example; 
as  Benjamin  Franklin's  inscription  runs,  it  *was 
piously  founded  for  the  relief  of  the  sick  and  miser- 
able.' That  purpose  is  still  true  of  modern  hospi- 
tals, we  trust;  but  there  are  now  two  other  pur- 


Hospital  Talk  205 


poses  of  a  hospital,  —  the  study  of  disease  and  the 
teaching  of  medicine.  Many  well-to-do  and  well- 
informed  people  forget  those  last  two  purposes; 
and  sometimes  in  talking  to  poor  patients  we  forget 
them,  too;  but  the  poor  patients  don't  forget  them. 
They  exaggerate  the  evil,  as  they  think  it.  They 
don't  know,  or  they  ignore  the  fact,  that  competent 
and  experienced  chiefs  are  responsible  for  every 
hospital  ward,  and  that  the  chiefs  have  junior 
assistants.  Many  of  the  patients  see  the  assistants 
only  and  eventually  leave  the  hospital  proclaiming 
that  they  have  been  in  the  hands  of  students.  In 
frequent  instances,  when  examining  old  hospital 
patients,  of  fair  intelligence  even,  I  find  that  they 
know  nothing  of  any  surgeon-in-chief,  and  can't 
name  the  man  who  operated  on  them.  These  are 
old  tales,  of  course;  and  of  no  special  consequence 
except  as  showing  how  little  trust  you  can  put  in 
the  story  of  the  average  hospital  patient. 

"Not  only  is  the  purpose  of  the  hospital  greatly 
broader  than  it  was,  but  the  obligations  of  the  staff 
are  vastly  more  burdensome.  In  the  old  days,  the 
surgeon  or  physician  *went  on  duty'  at  the  hospital 
for  three  or  four  months  of  the  year.  His  object 
was  to  do  his  share  towards  caring  for  the  city's 


206  A  Doctor's  Table  Talk 

sick  poor.  His  action  was  regarded  as  simple 
charity.  He  thought  of  it  as  nothing  else.  Inci- 
dentally, perhaps,  he  might  give  a  few  clinical  lec- 
tures to  medical  students. 

"  In  the  course  of  time  all  that  has  been  changed ; 
gradually  the  hospital,  with  its  associated  medical 
school,  has  become  the  centre  of  medical  life  in  the 
community.  Members  of  the  staff  are  now  on  duty 
for  six,  nine,  and  even  twelve  months  of  the  year. 
The  labors  of  these  public  servants  have  come  to  be 
excessive,  out  of  all  proportion  to  the  recognition, 
or  any  other  reward,  which  the  men  get.  In  many 
cases,  happily,  the  problem  of  proper  values  is 
working  itself  out.  In  most  progressive  communi- 
ties, nowadays,  special  hospital  wings  or  *  private 
wards'  are  reserved,  in  which  the  staff  lodge  and 
tend  their  private  patients,  charging  regular  fees. 
So  they  relieve  immensely  the  strain  of  their  work; 
and  save  time  and  strength  by  concentrating  their 
'public'  and  their  private  patients  under  one  roof. 
In  a  very  few  old-fashioned  hospitals  the  inhuman 
practice  still  prevails  of  taking  the  best  of  a  physi- 
cian's strength  fer  public  charity  work,  and  then 
driving  him  forth  to  make  his  bread  and  see  his 
private  patients  at  their  homes  or  in  a  number  of 


Hospital  Talk  207 


necessarily  inferior  private  hospitals.  I  'm  told  that 
in  Boston  the  eccentric  people,  not  content  with 
two  splendid  public  or  semi-public  hospitals,  — 
pricelessly  equipped,  and  capable  of  indefinite 
expansion  for  the  benefit  of  private  patients,  — 
I'm  told  that  the  people  there  are  planning  to 
build  an  extravagant,  independent,  and  distinct 
private  hospital,  duplicating  the  present  equip- 
ments, and  calling  upon  the  already  over-rushed 
profession  to  man  these  extra  works." 

"It's  all  true,  in  a  measure,"  I  said,  "though  you 
do  somewhat  exaggerate  the  situation.  The  fact  is 
that  many  surgeons  especially  welcome  this  make- 
shift scheme,  as  a  relief  from  conditions  which  were 
becoming  intolerable." 

Our  train,  by  this  time,  was  far  down  the  state, 
racing  througlv  the  Merrimac  Valley,  and  by  the 
side  of  those  beautiful  stretches  of  river  which  the 
rails  follow  as  far  as  the  Massachusetts  city  of 
Lowell.  We  had  gone  to  the  dining-car,  and  were 
dawdling  over  the  conventional  railway  luncheon. 

"After  all,"  I  continued,  "the  good  which  our 
hospitals  are  doing  seems  to  be  greater  every  year; 
and  the  dread  of  hospitals  is  certainly  less  than  when 
you  and  I  first  knew  them.  In  spite  of  the  modern, 


2o8  A  Doctor's  Table  Talk 

impersonal,  organized  charities,  and  the  more  or 
less  communistic  sentiment  which  is  coming  to 
prevail,  I  find  that  an  interest  and  a  care  for  in- 
dividual patients  is  more  frequent  than  it  was 
twenty  or  thirty  years  ago.  Then  we  were  satur- 
ated with  the  bad  German  tradition,  which  a  for- 
mer generation  of  students  had  brought  home  with 
them.  Hospital  patients,  especially  'out-patients,' 
were  driven  like  sheep,  and  their  personal  feelings 
were  ignored.  I  remember  some  of  my  old  teachers, 
men  still  living,  whose  public  insulting  questions 
and  callous  maulings  of  decent  men  and  innocent 
young  women  made  me  groan  and  shudder  in 
spirit.  The  good  done  by  such  doctors  —  outside 
of  mere  inevitable  mechanical  treatment  —  must 
have  been  less  than  nothing.  Now,  we  are  on  better 
ground,  as  it  seems.  We  are  developing  an  Ameri- 
can hospital  method,  so  to  say;  thanks  in  part  to 
publicity,  but  especially  to  Cabot  and  his  Social 
Service  preachments.  Concentrate  on  the  indi- 
vidual; don't  bind  up  your  patients  in  Inflexible 
groups;  learn  their  stories;  follow  them  to  their 
homes;  succor  and  assist  them;  stimulate  and  In- 
spire them.  That  Is  the  present  teaching,  and  for 
such  teaching  we  should  have  been  hooted  Into 


Hospital  Talk  log 


bedlam  a  few  years  ago.  It's  a  method  as  old  as 
Christianity;  but  it  was  unorganized  and  almost 
obsolete,  until  Cabot  again  saw  its  possibilities; 
revived  it,  organized  it,  dressed  it  up,  told  the  world 
about  it,  and  replanted  it  for  our  present  delecta- 
tion. 

"On  the  other  hand,  of  course  there  is  the  serious 
and  growing  danger  of  *  hospital  abuse.'  Thousands 
of  unscrupulous  persons  have  learned  that  they  can 
be  treated  for  little  or  nothing  at  public  hospitals, 
and  by  highly  trained  men.  Being  without  self- 
respect,  they  abuse  that  privilege.  Such  abuse  is 
another  problem,  which  our  much-talked-of  hospi- 
tal-for-the-middle-class  would  help  to  solve.  The 
other  day,  one  of  our  friends  in  a  New  England 
hospital,  with  much  spirit  informed  me  that  in  the 
'West'  they  do  better;  that  out  there  hospital  abuse 
is  almost  unknown;  that  practically  every  patient 
who  enters  a  Western  hospital  must  pay  something, 
according  to  his  means.  I  don't  understand  it. 
I'm  sure  I  trust  it  may  be  so;  but  how  it  is  accom- 
plished, and  why  there  should  be  such  a  change  in 
human  nature  between  New  York  and  Chicago 
passes  comprehension." 

"From  many  aspects  large  modern  hospitals  are 


2IO  A  Doctor's  Table  Talk 

extremely  interesting,  and  growing  more  interest- 
ing," said  Ely  reflectively.  "I'm  inclined  to  think 
that  for  the  working  staff,  physicians  and  nurses, 
the  hospital  life  is  more  absorbing  than  is  univer- 
sity life  for  its  professionals,  —  if  we  except  the 
Fellows  of  Cambridge  and  Oxford.  In  the  past 
generation  there  has  been  the  development  of  a 
unique  hospital  community.  What  would  the  old 
quidnuncs  of  thirty  years  ago  have  said  to  a  young 
graduate  in  medicine  who  proposed  to  spend  five 
or  ten  more  years,  and  his  best  years,  in  hospital 
life?  They  would  probably  have  thought  him  an 
amiable  lunatic.  We  should  invent  some  word 
more  dignified  than  *  Resident'  for  the  man  who 
chooses  that  life.  You  notice  that  the  number  of 
Residents  in  our  best  hospitals  is  increasing.  The 
presence  of  such  men  in  hospitals  is  surely  add- 
ing to  the  imp)ortance  and  stability  of  a  hospital 
career.  A  Resident  is  becoming  as  important  a  part 
of  a  hospital  service  as  is  the  Chief-of-Staff  himself. 
The  junior  men,  internes  and  externes,  should  never 
have  been  given  such  uncontrolled  powers  as  they 
had  a  few  years  ago.  That  was  an  accident  in  hos- 
pital development.  Old-time  surgeons,  when  they 
established  interneships,  never  intended  that  their 


Hospital  Talk  21 1 


assistants  should  have  important  independent  pow- 
ers; and  for  years  they  had  no  such  powers.  They 
were  minutely  supervised  by  their  chiefs.  With 
the  enormous  expansion  of  modern  hospitals,  how- 
ever, the  work  and  responsibilities  of  internes  piled 
up  in  proportion,  —  the  tasks  were  beyond  the  lim- 
ited experiences  and  capacities  of  the  young  men; 
and  yet  they  met  them  and  assumed  them  with 
the  splendid  assurance  of  youth.  Now  we  have  the 
Resident,  who  shall  temper  the  wind  to  the  shorn 
novice.  Even  as  it  is,  a  two  years'  interne  service 
in  a  busy  hospital  gives  a  man  an  experience  in  the 
use  of  his  tools  which  an  ordinary  lifetime  of  private 
practice  could  not  supply.  Of  men  and  women  he 
comes  out  ignorant.  Them  he  has  still  to  learn." 

"Another  difficult  problem  in  this  community 
life  of  yours,  Ely,  is  the  trained  nurse  problem,"  I 
ventured.  "Human  nature  is  human  nature;  and 
when  you  have  thirty  or  forty  young  men,  and  one 
or  two  hundred  young  women  under  one  roof,  and 
in  the  most  intimate  of  all  relationships  short  of 
marriage,  it's  often  a  question  how  the  situation  is 
to  develop  itself.  Happily  all  these  folks  are  very 
hard-worked;  otherwise  I  suspect  that  Hymen  and 
other  less  reputable  gods    and    goddesses  would 


212  A  Doctor's  Table  Talk 

find  themselves  under  a  heavy  strain.  The  wonder 
is  that  marriage  is  hot  far  more  common  among 
these  very  marriageable  people.  That's  one  aspect 
of  the  trained  nurse  problem;  and  I  think  we'd 
best  leave  it,  with  other  aspects,  to  the  experts. 
One  point,  though,  —  a  reply  to  all  the  severe  criti- 
cism of  trained  nurses,  —  and  the  poor  things  are 
criticized  more  unfairly  than  any  other  people  in 
the  world  except  servants  and  doctors;  —  the  pro- 
per standard  reply  is  this,  that  they  are  quite  as 
human  and  liable  to  error  as  the  rest  of  us.  I  often 
think  that  on  account  of  the  almost  incredible  inti- 
macy which  must  exist  between  nurse  and  patient, 
the  position  of  a  nurse  in  private  practice  is  one 
of  the  most  difficult  positions  conceivable.  Two 
young  sisters,  or  husband  and  wife,  are  more  inti- 
mate, but,  with  those  exceptions,  comparisons 
cease. 

"Now  the  nurse-patient  intimacy  is  a  forced  one: 
a  normal  family  is  going  on  in  its  usual  fashion, 
when  suddenly  the  son  of  the  house  becomes 
acutely  ill.  A  doctor  is  called,  and  to  aid  him  in  his 
labors,  he  promptly  installs  a  strange  young  woman 
in  the  young  man's  bedroom.  She  is  to  minister 
unto  him  day  and  night,  and  to  perform  all  the 


Hospital  Talk  213 


necessary  offices  of  the  toilet.  To  a  certain  extent 
mother  and  sisters  are  excluded,  and  the  strange 
young  woman  assumes  an  attitude  of  proprietor- 
ship and  responsibility,  which,  under  any  other 
circumstances,  would  seem  monstrous  and  incred- 
ible. To  become  a  gracious  presence  in  that  house- 
hold, such  a  young  woman  must  be  endowed  with 
the  tact,  the  virtues,  and  the  ability  of  an  arch- 
angel. While  the  illness  is  grave  and  acute,  all  other 
considerations  are  smothered,  but  as  soon  as  the 
patient  begins  to  mend,  his  family  begin  to  won- 
der; and  unless  they  are  old  hands,  familiar  with 
illness  and  with  trained  nurses,  they  quickly  begin 
to  chafe  without  understanding  clearly  the  cause 
of  their  discomfort.  One  morning  the  mother  of 
the  family  mysteriously  summons  the  doctor  to  a 
conference  in  her  own  room  before  he  visits  the 
patient.  She  has  no  doubt  that  Miss  Minns,  *the 
nurse  you  sent  us,  is  an  excellent  person  and  is  well 
trained;  yes,  you've  employed  her  for  five  years .^ 
Yes,  but  should  she  not  wear  a  cap  while  on  duty; 
not  the  rule?  Oh,  well;  she  understood;  —  and 
should  not  Miss  Minns  sweep  under  the  bed  every 
day;  —  supposed  she  did.''  —  no,  not  every  day. 
And,  is  it  necessary  for  her  to  go  out  for  two  hours 


214  ^  Doctor* s  Table  Talk 

every  afternoon  ?  —  had  supposed  that  nurses 
always  stood  by,  in  case  of  accidents;  —  yes; 
probably  she  is  mortal,  and  must  preserve  her 
health;  but  she  is  so  quiet,  and  never  tells  any- 
thing;—  leaves  that  for  the  doctor?  Oh,  didn't 
understand.  But  surely,  a  nurse  should  not  object 
to  eating  in  the  kitchen  and  carrying  dear  Jack's 
trays  up  to  him  six  times  a  day;  it's  only  four 
flights.  No  longer  customary  .>*  Oh;  then  I  suppose 
.  .  .  well;  all  right;  thank  you.  I  won't  detain 
you  any  longer  now.' 

"The  weary  doctor  escapes,  but  on  the  next 
floor  he  is  waylaid  by  his  patient's  elder  sister, 
supported  by  her  maiden  aunt  —  *a  most  experi- 
enced woman,  and  accustomed  to  illness.'  *So 
sorry  to  trouble  you,  but  don't  you  think  that 
mother  is  looking  dreadfully?  No  more  than  you'd 
expect?  Perhaps  not,  but  why  should  not  Miss 
Minns  give  her  a  good  massage  treatment  every 
night  after  mother  goes  to  bed?  She's  not  trained 
or  engaged  for  that  sort  of  work  ?  —  must  get  a 
regular  masseuse?  Oh;  Miss  Minns  seems  so  kind 
and  interested,  had  supposed  she'd  be  only  too 
glad  to  help  mother;  and  with  her  high  wages,  too.* 
And  so  on  day  after  day.  In  my  experience  a  nurse 


Hospital  Talk  215 


captures  the  family  at  once,  or  else  she  is  a  target 
for  criticism  throughout  her  stay.  Of  course  the 
nurse  is  not  perfect;  very  likely  she  is  of  a  type 
peculiarly  strange  or  distasteful  to  that  especial 
family.  Often  she  is  their  superior  In  breeding  and 
education,  even  though  the  family  appear  well-to- 
do  and  well  placed.  This  the  family  recognize 
and  resent.  All  other  things  being  equal,  however, 
and  the  superficial  relationship  being  in  no  way 
strained,  the  position  is  a  difficult  one  for  all  con- 
cerned. The  nurse  often  feels  suspicious  and  on 
guard;  in  her  distress  or  through  native  dullness, 
she  accentuates  her  own  faults;  while  the  afflicted 
family.  Invaded,  dispossessed,  managed,  and  oc- 
casionally ignored,  accumulate  a  sense  of  outrage, 
which,  though  Intangible,  Is  none  the  less  real. 
Whenever  a  nurse  tells  me  that  she  fears  her  em- 
ployers are  dissatisfied,  and  that  perhaps  she  had 
better  go,  I  always  say:  'Go;  at  once;  you  can't  go 
too  quickly,  both  for  your  own  reputation  and  for 
this  family's  peace  of  mind.  Later  they  will  under- 
stand your  action,  and  will  have  nothing  but  a  kind 
report  of  you  to  make.' 

"We  seem  to  have  gone  far  outside  of  our  hos- 
pital talk,  Ely;  but  we  agreed  to  leave  hospital 


2i6  A  Doctor's  Table  Talk 

nurses  to  experts.  I  have  been  relieving  my  mind 
about  nurses  in  private  practice;  and  those  are  the 
nurses  about  whom  you  and  I  know  most." 

"Let  me  say  one  more  word  on  the  subject,"  he 
replied.  "There  is  a  period,  a  mere  moment,  per- 
haps, when  the  hospital  nurse  is  breaking  the  shell 
and  emerging  as  a  private  nurse.  Then  is  the  time 
when  all  the  good  friendly  folks  gather  about  her, 
celebrate  her  'graduation,'  and  get  some  amiable 
man,  who  often  knows  nothing  of  his  subject,  to 
make  a  pleasant  little  speech  telling  the  class  what 
nice  young  women  they  are,  and  how  they  are '  ded- 
icating themselves  to  a  noble  career.'  Or  else,  the 
fatuous  man  has  been  primed  by  some  knowing 
woman,  and  so  takes  the  other  tack,  telling  the 
happy  and  well-meaning  neophytes  that  they  must 
n't  be  too  smart;  that  they  are  put  here  to  serve! 
that  the  human  lot  is  hard  at  the  best;  and  that 
they  must  n't  think  they  know  all  there  is  to 
know. 

"Of  course  they  don't  know  anything.  They're 
nothing  but  youngsters.  You  can't  expect  a  parcel 
of  girls,  from  twenty-one  to  twenty-three  years  old, 
to  take  a  very  serious  philosophical  view  of  life. 
They  resent  the  'noble  career'  talk  as  gammon, 


Hospital  Talk  217 


and  the  harsh  instruction  as  preaching.  Mostly 
they  have  taken  up  nursing  for  a  living,  as  they 
might  take  up  teaching  or  dressmaking.  They  are 
glad  of  honest  advice  straight  from  the  shoulder, 
and  no  nonsense.  Don't  think  that  I  fail  to  under- 
stand and  value  the  fine  ethical  side  of  the  nurse's 
career;  but  in  my  knowledge  that  fine  side  of  the 
life  is  developed  out  of  experience,  sorrow,  struggle, 
and  time.  With  women  as  well  as  with  men,  the 
'noble  career'  is  a  thing  of  painful  and  laborious 
growth.  As  a  fact  a  majority  of  nurses  fail  to  de- 
velop that  career  at  all,  because  most  of  them 
marry  while  still  in  the  joyous  age.'* 

The  solemn  converse  of  young  professional 
people  always  interests  me.  It  is  not  babble;  and 
sometimes  it  is  informing,  because  it  shows  how 
the  wind  sets.  Students  of  law  and  medicine  and 
young  practitioners  seem  to  be  most  given  to  this 
sort  of  talk.  The  awful  person  who  chatters  of 
stocks  develops  his  awfulness  late  in  life;  and  the 
politician  is  nearly  always  acceptable,  because  the 
politician,  whether  wise  or  foolish,  deals  with  sub- 
jects of  widest  interest.  Moreover,  his  talk  is 
rarely  technical.  Medical  talk  in  public  —  "  doctor 


2i8  A  Doctor* s  Table  Talk 

rot"  as  one  of  my  tired  friends  calls  it  —  is  some- 
times heard  even  from  venerable  lips  which  should 
have  been  better  trained.  I  have  agonized  memo- 
ries of  hanging  on  to  trolley-car  straps  with  certain 
merciless  consultants,  while  they  poured  out  upon 
me  and  upon  our  long-eared  neighbors  the  details 
of  the  case  we  were  about  to  visit.  I've  tried  to 
escape  from  my  misery,  by  sitting  down  even  while 
my  companion  remained  standing,  but  that  ma- 
noeuvre stimulates  one's  tormentor  to  worse  aggres- 
siveness and  louder  shoutings.  The  best  plan  is  to 
murmur  appreciation  and  to  approach  a  listening 
ear  as  near  to  his  lips  as  decency  will  permit.  Even 
so,  painful  moments  arise,  as  when  he  nips  off  his 
discourse  suddenly,  and  demands  in  truculent 
tones  what  you  would  do  under  the  conditions  he 
has  described.  I  have  learned  to  say  that  I  can't 
tell  until  I  have  seen  the  patient. 

We  were  speaking,  however,  about  the  shop-talk 
of  young  doctors,  —  and  of  nurses,  too,  if  you 
choose.  I  like  to  hear  them  talk  their  talk  and  air 
their  views,  if  only  their  speech  be  in  season.  Let 
them  be  modestly  reticent,  though,  in  the  presence 
of  older  persons  whose  training  is  not  medical.  A 
young  doctor  by  his  talk  may  impress  the  village 


Hospital  Talk  219 


clown  or  drunkard,  but  not  the  lawyer  or  the  par- 
son. The  admiring  father  and  mother  of  the  para- 
gon may  well  bear  in  mind  the  same  advice.  I 
recollect  one  beautiful  afternoon  of  my  vacation. 
Our  little  company  were  canoeing,  and  stopped  at 
a  charming  camp  by  the  lakeside  to  pass  a  word 
with  friends.  The  ladies  of  that  camping  party 
were  given  to  pleasant  reading,  and  one  of  them  to 
much  sprightly  writing  also.  I  spent  that  long  sum- 
mer afternoon  listening  as  she  read  out  the  letters 
to  herself  of  a  young  medical  colt  —  a  woman  — 
who  was  assisting  a  famous  missionary  in  his  distant 
field.  The  letters  were  precisely  what  a  specialist's 
letters  addressed  to  a  layman  should  not  be,  — 
prolix,  technical,  gushing;  but  my  friend  thought 
them  delightful,  and  the  writer  an  entertaining 
and  beautiful  character.  To  the  professional  it  was 
all  crude,  sophomoric,  and  unspeakably  tiresome. 
After  some  few  words  about  the  place  and  her  sur- 
roundings, with  a  needlessly  smart  criticism  of  the 
overworked  surgeon,  her  immediate  superior,  the 
writer  went  on  to  discuss  "her  cases,"  the  numerous 
operations  at  which  she  assisted,  and  her  successful 
method  of  giving  chloroform.  The  partial  friend  to 
whom  this  stuff  was  addressed  was  entirely  pleased, 


220  A  Doctor's  Table  Talk 

but  I  doubt  if  the  writer  had  anticipated  the  larger ' 
audience. 

Shop-talk  and  enthusiasm  among  the  young  pro- 
fessionals themselves  is  another  matter,  and  to  be 
encouraged;  though,  indeed,  they  care  little  for 
our  encouragement.  By  directing  the  flow  of  talk, 
however,  the  older  and  more  experienced  man  may 
often  be  of  some  service.  Eager  beginners  are 
prone  to  concentrate  their  interest  and  their  discus- 
sion on  trivial  matters  of  routine  and  narrow  tech- 
nique, while  they  invariably  see  the  case  and  not 
the  patient.  Their  talk  will  foam  among  the  shal- 
lows of  bandaging,  apparatus,  salt  infusions,  pulses, 
points  in  diagnosis,  and  details  of  the  operation, 
instead  of  seeking  the  deeper  and  more  profitable 
currents  which  are  concerned  with  the  significance 
and  nature  of  "surgical  support,"  the  comparative 
value  of  methods  of  raising  the  blood  pressure  — 
their  dangers  and  advantages  when  applied  to  the 
case  in  hand ;  the  importance  of  a  diagnosis  of  local 
disease,  when  the  general  and  psychical  conditions 
are  considered ;  and  finally  the  value  of  any  oper- 
ation in  the  patient's  present  state. 

Medical  science  is  full  of  problems  waiting  to  be 
solved.    Well-educated  students  know  this;  but 


Hospital  Talk  221 


mostly,  when  undirected,  they  leave  the  solutions 
to  others.  In  spite  of  scientific  training  few  of  us 
carry  on  into  the  battle  of  life  a  true  scientific 
curiosity.  We  labor  to  live  merely,  and  it  suffices 
us  at  last  to  earn  our  daily  bread.  Rare  and  precious 
is  the  man  who  takes  into  middle  life  his  enthusi- 
asms and  his  zeal  for  investigating.  If  we  could  all 
so  take  them  the  rate  of  progress  in  science  would 
soon  be  doubled;  for  we  should  have  the  accom- 
plishments of  men  at  once  vigorous  and  ripe. 
Thank  God,  there  are  among  us  a  few  such;  and 
they  are  those  whom  the  world  calls  "great  men." 
Their  enterprise  not  only  carries  themselves  far 
beyond  the  van,  but  opens  other  eyes  still  young 
enough  to  see  the  possibilities  of  a  career.  Two  or 
three  creative  minds  arise  in  every  generation. 
These  men  may  live  without  obvious  reward;  in- 
deed, their  lives  may  pass  away  without  recogni- 
tion, but  happily  and  always  they  are  optimists; 
they  are  men  of  vision,  and  they  have  learned  that 
truly  their  works  do  follow  them. 


CHAPTER  X 

Reminiscences 

With  the  return  of  summer  Dr.  Primrose  is  back 
at  his  work;  he  has  visited  the  city,  and  has  fore- 
gathered with  his  friends  there.  But  he  is  not  yet 
the  old  Primrose.  He  walks  slowly,  he  minds  his 
steps,  he  chooses  to  ride  in  elevators,  and  he  goes 
early  to  bed.  Moreover,  he  is  reminiscent,  nodding 
his  head  as  he  recounts  some  ancient  tale.  He  is 
given  to  general  talk  rather  than  to  professional 
discussion. 

"  Scriba,"  he  said,  as  he  sank  into  my  easy-chair, 
"  I  've  just  encountered  a  donkey  at  the  club,  and 
I  *m  too  old  to  be  bothered  with  donkeys.  He  is  our 
excellent  classmate  Brattle,  and  he  has  cultivated 
the  unspeakable  habit  of  'cutting'  folks.  I  sup- 
posed that  that  inanity  went  out  of  fashion  with 
dueling,  cutting  off  your  eldest  son  with  a  shilling, 
and  other  barbarisms.  You  remember  Brattle  in 
college.  He  was  blatant  and  could  be  a  dreadful 
ass  when  in  liquor.  He  used  to  talk  about  his  ances- 


Reminiscences  223 


tors;  and  divide  all  the  world  of  his  acquaintance 
into  'gentlemen'  and  'cads.'  He  boasted  of  being 
a  Southern  'gentleman';  and  enlivened  our  dinner- 
table  by  informing  us  dumb-stricken  Yankees  that 
— '  You  Northern  cowards  would  never  have  licked 
the  South  if  you  had  n't  filled  up  your  ranks  with 
imported  Irishmen,  who  did  all  your  fighting  for 
you.'  He  had  no  sense  of  humor,  but  he  had  little 
fat  legs,  was  boisterous  and  impressive,  and  sang  a 
good  song  in  a  charming  tenor.  We  thought  that 
with  time  he  would  grow  out  of  his  follies,  but  I  fear 
we  were  mistaken.  He's  done  nothing  worth  re- 
cording since  leaving  college.  I  had  n't  seen  him 
for  ten  years,  when  this  morning  I  met  him,  held 
out  my  hand,  and  was  annoyed  and  disgusted  by 
being  cut  dead.  One  feels  like  asking  why  we 
admit  such  canaille  to  our  clubs,  anyway.  Fortu- 
nately I  remembered  that  delicious  anecdote  of 
Lincoln  and  the  traveling  Englishman.  It's  one  of 
the  best  of  Lincoln  stories. 

"This  Englishman,  you  must  know,  possessed 
happily  an  old  name,  a  faultless  tailor,  and  excel- 
lent introductions.  He  came  over  here  during  our 
Civil  War,  traveled  up  and  down,  and  was  much 
entertained  by  our  good-natured  fellow  country- 


224  ^  Doctor's  Table  Talk 

men.  Finally  he  turned  up  in  Washington,  and  was 
taken  to  see  President  Lincoln. 

"Mr.  Lincoln,  tired  but  good-hearted,  spoke  a 
few  words  to  the  fellow:  'So  you  have  been  travel- 
ing through  our  country,  Mr.  Howard;  and  I  sup- 
pose you've  seen  many  unusual  sights  and  cus- 
toms.' 

"'Yes,  Mr.  President;  and,  do  you  know,  they 
tell  me  it's  the  habit  of  gentlemen  in  this  country 
to  polish  their  own  boots.' 

" '  Indeed,'  said  Lincoln,  looking  at  him  sadly, 
*that  is  a  frequent  habit.  And  pray,  sir,  whose 
boots  do  you  polish?' 

"Almost  good  enough  to  be  true,  is  it  not.'*  I 
wanted  to  tell  it  to  Brattle,  as  he  turned  away  to 
talk  with  Croesus;  but  that  would  have  been  too 
awkward,  I  suppose. 

"Let  me  get  away  from  Brattle.  As  I  drove 
down  the  street  I  recalled  Ely's  story  of  Wendell 
Holmes  and  the  ladies'  luncheon.  Please  let  me 
tell  it:  The  old  gentleman  was  asked  to  meet  a 
number  of  people  at  luncheon.  As  he  entered  the 
drawing-room,  his  hostess,  in  some  distress,  met 
him  at  the  door,  and  said:  'Dr.  Holmes,  we're  so 
sorry  to  disappoint  you,  but  the  three  men  we  ex- 


Reminiscences  225 


pected  cannot  come.  Here  we  are,  four  women. 
You  will  have  to  take  us  all  out  to  luncheon.' 
*  Madam,'  said  the  ready  Autocrat,  'it  shall  be  my 
pleasure.   Forewarned  is  four-armed!'" 

I  looked  at  my  visitor  in  some  doubt.  "Jona- 
than Primrose,"  I  said,  "this  does  not  sound  like 
you.  Lie  down  there,  please,  until  dinner-time. 
We  will  have  a  short  and  quiet  evening." 

Ely  joined  us,  of  course.  It  was  many  weeks 
since  we  three  had  come  together.  The  talk  drifted 
until  we  fell  upon  the  time-honored  subject,  — 
what  leads  a  man  to  choose  his  profession. 

"Indeed,"  said  Ely,  "it  is  hard  to  see  what  else 
than  family  tradition  could  induce  a  young  fellow 
to  study  medicine.  Such  ones  as  Warren  and 
Shattuck,  Mitchell  and  Gross  must  turn  to  medi- 
cine, for  their  fathers  have  been  doctors  for  gener- 
ations. My  own  people  have  been  doctors  for  five 
generations;  and  I'm  sure  it  was  an  advantage 
to  me  to  grow  up  in  a  medical  atmosphere;  to  know 
the  difficulties  of  a  doctor's  life,  and  to  understand 
dimly  the  nature  of  scientific  thought.  But  what 
turned  you  towards  medicine,  Primrose?  Your 
people  were  not  doctors." 

"No,  they  were  always  lawyers.  The  first  thought 


226  A  Doctor's  Table  Talk 

of  being  a  doctor  came  to  me  in  childhood.  I  had 
an  unusual  experience.  When  I  was  eight  years 
old,  my  father  sent  me  with  one  of  my  brothers  to 
spend  three  summer  months  on  a  farm  in  the 
Genesee  Valley,  near  Rochester,  where  we  had 
many  friends.  That  summer  is  marked  with  a 
white  stone  for  me.  The  farm  is  a  beautiful  place 
in  the  township  of  Chili  —  '  Chy-ly,'  they  call  it. 
Black  Creek  —  the  *  crick*  —  meanders  through 
its  charming  fields ;  bits  of  primeval  forest  —  wood- 
lots  —  are  scattered  along  the  bottom  lands ;  and 
withal,  the  whole  region  has  about  it  an  air  of 
ancient  solidity  and  longtime  cultivation  and  pro- 
sperity, as  rare  as  it  is  captivating  in  this  new  land 
of  ours.  The  vast  grain-fields  of  the  Western 
prairies  had  not  then  destroyed  through  competi- 
tion our  modest  Eastern  farming;  and  the  Genesee 
country  was  famous  as  a  garden  of  the  Lord  and  a 
bountiful  granary.  The  five-  and  ten-acre  lots 
yielded  abundant  harvests  of  wheat,  corn,  oats, 
hay,  and  buckwheat,  while  the  groaning  orchards 
of  apples,  peaches,  pears,  and  plums  supplied  the 
markets  of  the  state. 

"The  old  wooden  farmhouse  in  which  we  lived 
with  our  kind  hostess,  a  farmer's  widow,  Mrs. 


Reminiscences  227 


Blake,  and  her  grown  daughter,  Nora,  stood  at  a 
crossroads  and  was  surrounded  by  its  barns  and 
outhouses,  its  corn-cribs,  home  orchard,  stacks,  and 
gardens;  while  across  the  wide  'square'  of  country- 
road,  here  almost  a  'common,'  were  the  brick  house 
and  belongings  of  our  one  neighbor,  Mr.  Joe  Gruen- 
dike. 

"We  urchins  were  turned  loose  upon  the  farms. 
Provided  we  reported  for  our  meals,  there  were  no 
restrictions.  Often  we  spent  our  days  afield  with 
the  men,  busy  with  haying,  reaping,  stacking, 
ploughing,  and  harrowing.  Again  we  wandered 
all  day  by  the  stream.  We  learned  the  simple  arts 
of  farmer-fishing.  We  learned  to  dive  and  swim; 
and  other  games,  less  bland  and  innocent,  I  fear  we 
learned.  A  small  boy,  Dennis  Fox,  skilled  in  field- 
sports,  came  forth  from  the  neighboring  village. 
Instructed  in  some  measure  by  a  prudent  mother, 
he  made  as  though  to  welcome  us,  but  we  knew 
that  his  heart  was  estranged.  His  years  were  ten. 
To  him,  city  boys,  as  he  regarded  us,  —  for  his 
vision  knew  nothing  beyond  Rochester,  —  to  him, 
city  boys  were  things  to  be  despised.  Did  they  not 
wear  shoes  and  stockings,  and  foppish  Rollo  hats, 
and  collars,  and  other  fooleries.''  Above  all,  were 


228  A  Doctor'' s  Table  Talk 

they  not  given  under  compulsion  to  that  abomin- 
ation of  brushing  the  teeth.  And  then,  they  knew 
not  how  to  fight. 

"  In  the  eyes  of  Dennis  Fox  we  were  fair  game, 
but  he  reserved  us  for  himself,  and  kindly  under- 
took our  education.  First,  he  induced  us,  when 
abroad,  to  forego  shoes  and  stockings;  and  to  our 
untold  agony,  he  forthwith  led  us  through  a  stubble- 
field  of  wheat,  then  freshly  cut.  Our  hats  were 
greatly  improved  by  removing  their  ribbons  and. 
immersing  the  hats  themselves  for  a  half-hour  in 
the  stream.  We  were  taught  to  dispense  at  once 
with  collars.  Our  most  objectionable  custom,  by 
far,  however,  was  an  absurd  use  of  the  English  lan- 
guage. It  was  finicking,  unpicturesque,  and,  for 
the  want  of  expletives,  entirely  lacking  in  force. 
We  must  learn  at  once  to  swear;  and  remember  — 
those  were  the  days  of  gross  and  reckless  swearing. 
I  recollect  retiring  to  a  remote  corner  of  the  rail 
fence  in  a  distant  field  and  practicing  timidly  some 
of  the  strange  new  words  which  this  young  rascal 
taught  us. 

"Happily  for  our  peace  of  mind,  Dennis's  next 
move  proved  less  successful.  He  had  not  yet  licked 
us,  and  as  we  were  unskilled  in  rough-and-tumble 


Reminiscences  229 


fighting,  he  stated  that  we  might  pick  up  a  little 
learning  while  he  practiced  himself  upon  us.  Un- 
happy boy!  He  forgot  that,  though  unskilled,  we 
were  not  without  ambition.  His  first  assault  was 
delivered  by  means  of  the  needless  and  ugly  kick 
upon  my  childish  person.  Now  the  kick  classical, 
as  all  the  world  knows,  is  addressed  from  the  rear 
and  upon  that  portion  of  the  body  which  is  best  pro- 
tected from  violence.  Moreover,  though  the  first 
attack  may  be  unexpected,  and  the  assailed  person 
be,  by  so  much,  taken  at  a  disadvantage,  it  is  im- 
probable that  he  will  again  be  caught  unawares.  I 
dissembled  my  indignation  and  planned  a  reprisal 
—  then  new  to  me.  A  minute  later  Dennis  pre- 
pared to  resume  the  assault.  I  saw  him  fall  back 
into  position.  In  an  instant  he  drew  off,  and  drove 
at  me  viciously,  but  I  was  too  quick  for  him.  As  his 
bare  foot  reached  me  I  stepped  aside,  and  leaning 
backwards,  I  seized  his  upraised  ankle  in  my  hand. 
Instantly  I  realized  my  advantage.  I  had  him 
*cast';  he  was  hors-de-combat.  I  sprang  forward, 
still  grasping  his  leg.  Behind  me  he  rolled  on  the 
ground,  helpless,  blinding  the  summer  air  with 
shrieking  oaths.  Then  he  yelled  empty  promises 
of   reform.     Treacherous   viper,   we    knew   their 


230  A  Doctor's  Table  Talk 

worth,  and  we  were  through  with  Dennis.  My 
brother  and  I  threw  ourselves  upon  him,  held  his 
hands,  and  extracted  from  him  a  promise  that  he 
would  depart  from  us  instantly.  Then  we  let  him 
up;  he  glared  furiously  and  oppressed  us  with  his 
words;  but  as  we  had  armed  ourselves  with  sticks, 
and  stood  our  ground,  he  left  us  suddenly,  and 
ran  off  along  the  road  in  a  cloud  of  insinuations. 
He  returned  no  more. 

"We  spent  two  glorious  summers  at  the  farm; 
the  happiest  of  childhood,  as  I  think;  but  who  shall 
say,  when  all  was  glad.^  I  ponder  now  on  health 
such  as  we  had,  and  wonder  where  it's  gone.  Why 
do  we  squander  that  rich  blessing,  our  capital  in 
life,  if  we  but  knew.?  And  looking  back  through 
forty  years  I  see  two  eager  boys  scampering  down 
the  lane,  scouring  the  wood,  following  the  teams, 
hunting  the  barn  for  eggs,  fishing  the  creek,  digging 
the  garden,  eating  like  young  Indians,  sleeping 
deeply  the  night  of  twelve  hours  through,  and  al- 
ways under  the  gentle  care  and  humorous,  kindly 
eyes  of  Nora,  the  daughter,  and  of  Mother  Blake. 

"Into  the  midst  of  this  Arcadia  tragedy  came. 
It  was  mid-August;  the  wheat  and  oats  were  reaped 
and  stacked  and  stored.  The  barns  were  bursting 


Reminiscences  23 1 


with  grain.  The  time  to  *  thrash'  had  come.  We 
knew  something  of  this  glorious  climax  to  the  sum- 
mer harvest.  The  great  lumbering  threshing- 
machine,  horse-drawn,  would  make  its  rounds 
among. the  neighboring  farms.  I  may  not  guess  its 
ownership  or  the  plan  of  its  assignment;  but  all  the 
farmers  seemed  to  share  it,  though  it  was  stored 
and  operated  by  two  of  our  neighbors  down  on  the 
Scottsville  road,  —  'old'  Mr.  Desmond,  as  we 
called  him,  and  his  nephew,  our  special  chum, 
Frank  Hale.  That  gay  and  kindly  heart,  Frank 
Hale,  —  I  recollect  him  well,  —  the  friend  of 
children,  dogs,  and  birds,  and  other  harmless 
things.  He  is  my  ideal  of  a  fine  upstanding  yeoman; 
some  twenty-five  years  old,  —  six  feet,  perhaps,  — 
broad-chested,  blond  and  ruddy;  bearded,  as  the 
mode  then  was;  expert  in  country  life;  —  a  farmer, 
carpenter,  blacksmith,  woodsman  wise.  During 
those  weeks  in  which  threshing  was  done,  he  drove 
and  kept  the  horses,  cleaned  the  gear,  fed  the  ma- 
chine's great  maw,  and  at  night  returned  home 
with  Mr.  Desmond,  whom  he  loved  and  cherished 
as  a  father.  The  tie  between  the  two  was  rarely 
deep  and  strong.  I  know  not  their  private  history, 
but  they  seemed  much  alone  in  the  world;  both 


232  A  Doctor's  Table  Talk 

bachelors,  with  no  other  kindred  in  my  time.  The 
uncle,  serious,  silent,  effective,  respected;  the 
nephew,  alert,  joyous,  active,  popular  —  they  held 
their  place,  an  institution  of  the  countryside. 

"That  threshing  week  with  us  I  well  recall.  It 
seemed  a  free  and  gala  time.  Work  in  the  fields  was 
stopped.  The  women-folk  were  deep  in  plans  of 
feeding  many  men.  Eating  and  drinking  were  to 
the  fore.  The  great  barnyard  was  cleared;  a  stout 
railed  pen,  or  circuit  fence,  was  built  in  which  to 
raise  the  stack.  The  mighty  doors,  front  and  rear, 
were  opened  wide;  all  lumber  was  removed;  the 
heavy  machine  was  rolled  upon  the  floor,  its  horses 
taken  out,  its  jaws  uncoupled,  and  the  long  flume 
or  chute,  whatever  be  its  name,  for  bearing  straw, 
led  out  across  the  railed-in  pen  beyond. 

"On  Monday  morning  early  we  began.  There 
was  a  grand  commotion.  Two  horses  tramping 
out  a  circle  in  the  fore  yard  furnished  the  power. 
The  mighty  engine  clattered  and  groaned  and 
trembled,  devouring  sheaves  of  wheat;  its  great 
steel  teeth  seizing  the  grain,  rending  it  from  its 
straw,  pouring  it  into  bins;  while  the  discarded 
straw,  whirling  in  clouds  of  dust,  was  tossed  aloft 
along  the  chute,  and  piled  upon  the  stack.    Old 


Reminiscences  233 


Desmond  drove  the  team,  around  and  around; 
while  Frank,  our  friend,  stood  on  the  feeding- 
board  above  the  pole,  and  all  day  long,  deft  and 
unceasing,  fed  sheaves  and  sheaves  of  grain  into 
the  jaws.  Our  many  men  about  the  place  stood  to 
them  both,  but  mostly  they  were  busied  on  the 
stack,  receiving,  sorting,  piling  up  the  straw.  It's 
hard  to  say  why  such  days  should  be  joyous  and 
clearly  marked,  —  perhaps  the  novelty;  perhaps 
because  the  men  all  work  in  gangs,  near  to  the 
house,  and  have  no  evening  tramp  for  home. 

"  For  five  days  long  our  threshing  lasted.  Slowly 
the  wheat  is  sifted  from  the  straw;  the  bins  are 
filled  and  the  great  stack  piled  like  a  classic  dome 
above  the  barn.  Now,  Desmond  and  Frank  Hale, 
with  their  machine,  have  traveled  on  to  other 
farms.  Our  barn  is  swept;  the  doors  are  closed; 
and  all  made  snug  against  the  coming  fall. 

"Late  on  a  sultry  afternoon,  a  week,  perhaps, 
after  the  work  was  done,  I  sat  upon  the  horse-block 
in  front  of  Gruendike's  house,  awaiting  the  call  to 
supper  from  Nora  Blake's  great  bell.  The  day's 
work  was  over  save  for  the  milking  and  other 
evening  *  chores.'  In  shirt-sleeves,  noisy,  crowding, 
and  cheerful,  Gruendike's  men  had  filed  into  his 


234  ^  Doctor's  Table  Talk 

great  kitchen  to  eat  the  evening  meal.  Kind  young 
Mrs.  Gruendike  presided  at  the  stove,  and  served 
with  generous  profusion.  Outside  I  sat,  and  watched 
the  sun,  still  a  good  hour  high.  On  the  great  barn 
floor,  opposite,  a  rooster  flapped  and  strutted.  A 
clucking  hen  beneath  a  barrow  gathered  her  chick- 
ens close.  The  horses  snorted  and  stamped  and 
shook  their  racks.  Thin  clouds,  updrifting  in  the 
western  sky,  foretold  to-morrow's  rain.  The  wal- 
nut tree  above  me  stirred  to  a  passing  breath. 

"  From  far  along  the  road  a  dog's  quick  bark  — 
sharp  as  in  fright  —  struck  on  my  ear.  The  distant 
rattle  of  a  team  driven  at  speed  grew  loud  and 
louder.  Turning,  I  saw  a  line  of  dust  come  up  the 
slope.  Snorting  and  straining,  two  horses  dragged 
a  heavy  wagon,  crested  the  hill,  trotted  across  the 
grass,  and  stopped  before  the  house.  Three  men 
sat  on  the  driving-seat.  On  straw  behind,  a  blanket 
at  his  head,  I  saw  a  figure  laid;  blood  smeared 
the  face.  Beside  him  poor  old  Desmond  held  a 
hand. 

"As  the  wagon  stopped,  Desmond  sprang  up, 
his  kind  face  drawn  and  anxious.  *Joe!'  he  cried, 
*Joe  Gruendike!'  There  was  no  mistaking  the  call 
of  deep  distress.    In  a  moment,  the  farmer  came 


Reminiscences  235 


running  from  the  kitchen  door,  his  napkin  in  his 
hand,  his  red  beard  flying,  his  eye  alert. 

"'Joe,'  said  Desmond,  leaning  out  from  the 
wagon  and  speaking  low  and  quick,  *  my  boy  Frank 
is  awful  hurt;  his  arm  tore  off  in  the  machine;  hitch 
up,  and  drive  like  hell  for  Dr.  Hicks:  up  there 
next  to  the  church.  Send  him  to  the  house  as 
soon  as  he  can  git  there;  and  have  him  fetch  his 
tools.' 

"That  scene  is  not  to  be  forgotten:  the  steaming 
horses;  the  earnest  men  in  front,  their  faces  turned 
towards  us;  the  big  green  country  wagon,  splashed 
and  stained;  the  great  bed  of  straw,  in  which 
Frank  lay  groaning  and  unconscious;  Desmond,  — 
hatless,  horrified,  but  cool,  —  leaning  out  over  the 
wheel,  his  old  hands  gripping  the  rim,  his  old  blue 
shirt  thrown  open  at  the  neck;  Gruendike  stand- 
ing, —  tense,  shocked  and  sympathetic,  —  taking 
his  orders ;  and  in  the  background,  at  the  open  door, 
the  farmer's  faithful  wife,  puzzled  and  uncertain; 
two  children  at  her  skirts,  while  behind  her  in  the 
dim  passage,  the  men  stood  craning,  fearful  and 
curious. 

"By  the  farmer's  side,  unnoticed,  shrank  the 
little  'city  boy,'  his  eyes  swimming  with  fright  and 


236  A  Doctor's  Table  Talk 

sympathy;  his  hand  gropingly  outstretched  to  take 
that  of  his  wounded  friend.  It  was  a  doctor  that 
they  wanted,  and  at  once.  A  doctor  should  make 
all  right,  if  only  he  were  here.  The  year  before, 
when  a  young  friend  was  struck  and  mangled  on  the 
railway,  this  boy  had  heard  that  very  cry  for  help. 
Then  up  from  the  background  of  his  baby  life  there 
came  that  other  cry,  which  the  old  minister  at 
home  used  to  read  out,  as  the  people  knelt  in  church; 
*And  we  beseech  Thee,  O  Lord,  to  comfort  and 
succour  all  those  who  are  in  trouble,  sorrow,  need, 
sickness,  or  any  other  adversity.'  Here,  indeed, 
were  need  and  sickness.  In  some  dim  fashion  the 
child  felt  that  the  Lord  and  Dr.  Hicks  must  both 
come  quickly.  Ah,  if  only  he  were  Dr.  Hicks. 

"As  Gruendike  strode  towards  the  big  barn,  I 
ran  by  his  side,  and  held  his  hand :  'Mr.  Gruendike, 
may  I  go  with  you;  perhaps  I  can  help.'  He  looked 
down  at  me  and  smiled,  for  big  Joe  Gruendike  was 
my  friend.  'Yes,'  he  said;  'jump  in  and  hang  on.' 
The  men  pulled  the  muddy  old  buggy  out  upon  the 
grass.  Bess,  the  freshest  horse  in  the  stalls,  was 
put  between  the  shafts;  all  buckles  were  drawn 
tight;  I  sat  huddled  in  the  seat;  whip  in  hand  Joe 
jumped  in  by  my  side,  and  within  five  minutes  of 


Reminiscences  237 


leaving  his  house  we  cantered  down  the  hill,  — 
while  Nora  Blake  rang  the  great  supper  bell. 

"The  sun  was  at  our  backs,  the  long  hot  road 
stretched  straight  before  us.  The  regular  thud, 
thud  of  the  old  mare's  hoofs  seemed  to  fill  up  the 
day,  while  Gruendike  with  his  flicking  whip  saw 
that  she  kept  her  pace.  Above  the  thistles  and 
goldenrod  by  the  roadside,  the  heated  air  shim- 
mered and  burned;  now  and  again  the  cry  of  a 
nesting  bird  was  heard;  the  fields  were  desolate; 
far  behind  us  the  dust  still  rose,  and  settled  where 
we  passed.  In  the  half-mile  before  us  a  few  cows 
loitered,  blocking  the  road.  We  came  up  and  I  saw 
that  Dennis  drove  them.  Switch  in  hand,  he 
laughed  and  jeered,  that  for  a  moment  we  were 
halted. 

"The  drive  was  five  miles  long.  At  sunset  we 
reached  the  cross-roads  and  the  church,  and  found 
the  doctor's  house,  next  door.  Dr.  Hicks,  with  coat 
off,  was  in  his  garden,  gathering  fruit.  We  called 
across  the  high,  green  picket  fence,  and  he  came 
out  —  a  tall,  dark,  rugged  man,  with  faithful  eye 
and  serious  face;  a  man  who  knew  his  work;  a  man 
to  trust.  We  told  our  tale. 

"Then  we  drove  slowly  back  again,  making  for 


238  A  Doctor's  Table  Talk 

Desmond's  place.  The  doctor  passed  us  on  the  road, 
his  famous  Morgan  speeding.  We  must  have  been 
a  half-hour  after  him  in  reaching  the  house.  Dr. 
Hicks  was  there,  but  all  was  over.  Poor  Frank  had 
died  in  the  wagon  going  home.  It  was  still  dusk; 
the  windows  not  alight.  The  place  was  sad  enough, 
the  house  one  of  those  dreary  two-story  carpenter- 
modeled  structures  most  common  in  city  suburbs. 
The  paths  leading  to  the  doors  were  almost  smoth- 
ered in  tall  Timothy  grass  awaiting  the  scythe. 
The  forlorn  little  front  door,  up  five  steps,  looked  as 
though  never  opened,  and  bore  upon  its  middle 
panel  the  twisting  handle  of  an  unused  bell.  From 
the  back  door  issued  an  old  woman,  *the  help,* 
bearing  a  great  basket  in  both  hands,  the  tears 
unheeded  streaming  on  her  cheeks. 

"Dr.  Hicks  came  out  leading  poor  Desmond, 
speechless.  Other  neighbors  gathered  with  us  and 
heard  the  tale.  The  accident  had  happened  towards 
the  hot  day's  close.  Frank  Hale  was  tired;  he  had 
been  *  feeding'  the  machine  for  many  hours.  He 
grew  careless  and  rushed  his  work.  On  a  sudden  he 
shouted,  'Stop.'  They  saw  him  leaning  forward, 
and  they  knew  his  arm  was  in  the  teeth.  An  instant 
halt  they  could  not  make.  The  horses  stopped,  but 


Reminiscences  239 


for  an  awful  spell,  the  works  went  on.  The  men  ran 
up;  they  saw  him  rise;  his  life  was  pouring  from  the 
mangled  stump;  he  looked,  smiled,  threw  up  his 
other  hand,  and  fell  unconscious  backward,  head- 
foremost, smashing  on  the  wagon-pole.  They  took 
him  up,  bound  straw  with  sheets  tightly  across  his 
arms  and  chest,  and  tried  to  rush  him  home.  He 
died  upon  the  road.  Perhaps,  had  they  not  moved 
him  from  the  barn  he  might  have  lived.  I  believe 
not,  —  not  with  his  broken  head. 

"Even  to-day,  with  a  veteran's  experience,  I 
think  of  that  old  accident  as  very  bad.  Imagine 
the  dreadful  mental  agony,  as  he  saw  his  arm  drawn 
in.  He  could  not  stop  it.  Then  the  teeth  reached 
his  shoulder  and  he  knew  his  chance  was  gone.  The 
bone  was  wrenched  from  the  socket,  and  dragged 
away.  That  was  the  end  of  thought.  He  fell.  For 
him,  as  we  all  know,  the  time  had  come;  but  brave 
old  Uncle  Desmond  must  go  on. 

"After  two  days  had  passed  they  buried  him, 
with  all  the  world  of  Chili  at  the  grave.  Good  Mrs. 
Blake  and  Nora,  with  us  two  boys,  drove  her  old 
buggy  to  the  house  and  hitched  beneath  a  tree. 
The  day  was  steaming  hot;  the  sun  beat  fiercely 
down.    The  doors  were  all  thrown  open.    As  we 


240  A  Doctor's  Table  Talk 

walked  up  the  path  to  the  front  steps  we  passed  a 
group  of  men  headed  by  Uncle  Desmond.  Joe  was 
there,  and  all  my  well-known  friends;  standing  in 
awkward  clothes,  and  unfamilar,  a  solemn  row; 
their  heads  were  bare;  their  faces  sad  and  set.  They 
were  both  choir  and  bearers  of  the  dead.  Within 
the  house,  in  the  forlorn  front  room,  garnished  with 
hair-cloth  and  a  mighty  volume  of  the  scriptures,  a 
plain  oak  coffin  stood.  The  room  was  given  over 
to  the  women;  to  me  they  all  seemed  old  or  middle- 
aged,  —  all  in  black  silk  and  shawls,  and  heavy 
lonesome  bonnets.  They  wiped  their  eyes  and  sat, 
or  stood,  and  whispered,  murmuring  sounds  about 
poor  Frank.  My  own  dear  Mrs.  Blake  became  as 
one  of  them,  and  looked  severe,  and  muttered  now 
and  then  a  word  in  some  adjacent  ear.  Nora  alone 
was  fresh  and  calm  and  sweet  —  a  breath  of  youth 
in  that  sad  company.  I  sat  against  the  wall,  low  on 
a  stool,  hidden  by  Mrs.  Blake. 

"Awkward  young  Mr.  Stiles  came  In,  —  the 
student-minister;  arrayed  in  heavy  black, and  white 
disjointed  tie.  He  held  a  service,  —  of  just  what 
form  one  cannot  say;  it  seemed  unending.  He  told 
about  our  Frank  —  his  fine  and  useful  life.  I  could 
have  told  it  better.    I  almost  cried  to  hear  the 


Reminiscences  241 


feeble  words.  He  wandered  on  and  on,  and  then  he 
prayed.  Dear  Lord,  how  he  did  pray!  He  spoke 
with  God  about  us  all,  and  all  our  doings.  I  thought 
within  myself  that  God  must  ever  weep  if  such 
despairing  words  ascended  to  the  throne  this  day, 
and  every  day  throughout  the  world.  But  then 
they  say  God  is  all-wise;  and  dwelling  there  in 
bliss  with  saints  and  other  joyous  ones,  where  sor- 
row is  unknown.  I  could  not  grasp  it  all.  I'd  never 
seen  a  funeral  before.  The  women  took  some  com- 
fort, shaking  their  heads  and  wiping  furtive  tears. 
Anon,  he  read  the  Bible,  —  not  happily,  but  long 
sonorous  verses,  —  naming  strange  names,  dealing 
with  death  and  pain  and  sin,  beyond  my  puny 
knowledge,  for  I  slept. 

"A  strain  of  music  sounded  as  I  woke.  The  sad- 
voiced  man  was  gone.  Outside,  the  tender  words 
of  a  familiar  hymn  rose  on  the  summer  air.  My 
Mr.  Desmond  and  his  farmer  choir  in  touching 
fervor  quavered  through  the  lines:  — 

"'Nothing  in  my  hand  I  bring, 
Simply  to  Thy  cross  I  cling.* 

"  I  wept;  I  broke  out  in  an  agony  of  childish  sobs. 
Kind  Dr.  Hicks,  who  stood  near  at  the  door, 


242  A  DocUir's  Table  Talk 

stooped  down  and  led  me  out.  The  men  and  wo- 
men about,  in  their  stern  faith,  now  dry-eyed, 
looked  on  unmoved;  all  but  our  Nora.  I  clung  to 
the  good  human  hand,  and  again  the  words  of  our 
clergyman  at  home  returned,  — '  in  trouble,  sor- 
row, need,  sickness.'  Ah,  if  only  Dr.  Hicks  had 
been  there  in  time.  Then  came  the  thought,  — 
when  I  'm  a  man,  that  shall  be  my  work. 

"In  the  shade  of  the  house,  beyond  the  line  of 
men,  we  stood  and  waited.  The  others  joined  us. 
For  us  little  boys  there  was  excitement  and  curiosity 
as  well  as  sadness.  But  my  brother  reproved  me 
for  my  outburst;  he  was  concerned  for  family 
dignity. 

"When  you  went  to  a  country  funeral,  in  those 
days,  you  saw  it  through.  There  was  no  unseemly 
scattering  of  the  people,  such  as  occurs  after  a  city 
service.  We  were  all  mourners.  So  now  we  mounted 
into  our  buggies  and  wagons,  and  waited.  Our  men, 
going  inside  the  house,  returned  with  shambling 
steps,  bearing  the  coffin.  They  were  new  to  the 
work;  their  hands  and  feet  disturbed  them;  as  for 
their  hats  they  knew  not  what  to  do,  and  so  they 
hung  them  on  the  picket  fence.  Laughter  is  near 
to  tears.    Now  and  again  a  woman,  or  the  little 


Reminiscences  243 


boys,  coming  to  the  gate,  broke  out  in  hysteric 
giggles  at  so  grotesque  a  sight,  —  beaver  hats,  slouch 
hats,  straw  hats,  each  with  its  handkerchief,  in 
solemn  disarray. 

"  Led  by  the  simple  hearse,  whose  driver  kept  the 
village  tavern,  we  passed  in  slow  and  sad  proces- 
sion to  the  now  distant  graveyard,  close  by  the 
church.  It  seemed  an  eternity,  but  so  best  could  we 
show  respect  to  Mr.  Desmond  and  the  dead. 

"Who  does  not  know  the  shabby  dreariness  of 
such  a  graveyard  scene.'*  —  the  walled-in  square  of 
land;  the  treeless  waste;  the  tumbled  stones;  the 
garish,  broken  shafts;  the  unkempt  gravel;  the 
weeds;  the  tangled  grass;  the  rusty  chains.  In  a 
remote  corner  we  gathered  at  the  open  grave.  The 
farmers  brought  the  coffin,  lowered  it  down,  and 
shoveled  in  the  soil.  Haltingly,  'Earth  to  earth, 
and  dust  to  dust'  was  said  by  Mr.  Stiles;  and  then 
again  the  men  and  women  lifted  a  scattered  voice 
in  last  salute: — 

'"When  I  rise  to  worids  unknown, 
See  Thee  on  thy  judgment  throne,'  — 

faithfully,  earnestly,  every  word  from  the  heart. 
"  I  tell  you,  my  friends,"  Primrose  concluded,  as 


244  -^  Doctor^ s  Table  Talk 

he  turned  towards  us  with  his  smile,  "those  are  the 
people  who  made  us  what  we  are;  those  are  the 
ones  with  whom  I  choose  to  live.  The  world  is 
better  for  their  being  here." 


CHAPTER  XI 

A  Letter  from  Scriba  to  his  Son  Thomas  at 
St.  Paulas  School 

Squam  Lake,  N.  H., 
25th  Sept.,  1911. 
My  dear  Tom: 

At  the  Twenty-fifth  Reunion  of  his  college  class, 
my  old  friend  Jack  Starling  made  a  famous  talk  on 
Asses.  Jack  has  the  misfortune  to  be  of  the  class 
one  year  ahead  of  your  father's,  so  that  I  missed 
that  talk,  but  fragments  of  it  reached  me.  In  his 
speech,  Jack's  method  was  to  select  from  the  class- 
list  sundry  men  well  known  in  college  days;  by  a 
few  vigorous  strokes  to  recall  their  leading  qualities; 
then,  with  charming  humor,  to  assert  that,  after 
all,  they  belonged  to  the  genus  Ass,  assigning  each 
to  his  particular  variety;  for  you  must  know  that 
Asses,  like  Thackeray's  Snobs,  fall  into  certain 
groups.  There  is  the  Solemn  Ass,  the  Blatant  Ass, 
the  Fresh  Ass,  the  Ass  who  would  be  a  Man  of  the 
World,  the  Ass  for  whom  Women  sigh,  the  Sly  Ass, 
the  Pompous  Ass,  and  a  dozen  others.    It  was  a 


246  A  Doctor's  Table  Talk 

delicious  study;  and  then  Starling  left  to  his  hearers 
the  joy  of  it  all,  —  the  comparing  these  youths  at 
twenty  with  the  same  men  at  forty-five.  The 
words  were  so  kindly  and  mirthful  that  no  feelings 
were  hurt.  Insignificant  men  were  proud  to  be 
rescued  from  oblivion;  and  distinguished  men 
could  afford  to  laugh. 

Much  in  the  same  way,  I  have  often  thought, 
could  groups  of  men  other  than  Asses  be  studied,  — 
men  of  my  own  profession,  for  example,  might  tell 
by  their  lives  an  important  lesson;  if  their  lives 
were  presented  in  a  "before"  and  "after"  fashion; 
and  so,  by  a  series  of  object  lessons,  one  might  an- 
swer the  anxious  question  in  your  letter,  —  Shall 
I  follow  my  father  and  study  medicine? 

Apropos,  I  recollect  our  old  friend  Dr.  Farring- 
ton  saying  to  me  long  ago,  that  after  all,  medicine 
is  a  very  good  business.  The  average  doctor  is 
earning  a  fair  income  and  supporting  himself  years 
before  his  contemporaries  in  law  and  business  are 
doing  as  well.  No  right-minded  man,  however, 
turns  to  medicine  as  a  business,  —  that  you  know; 
—  and  Dr.  Farrington's  own  fine  career  is  far 
removed  from  vulgar  thoughts  of  money-getting. 

Then,  again,  one  may  look  at  the  vocation  ques- 


Scriba  to  his  Son  Thomas  247 

tion  from  the  negative  point  of  view,  —  What  call- 
ing shall  I  avoid?  The  other  day  a  lady  told  me 
of  an  interesting  experience.  She  had  been  lunching 
with  a  company  of  eleven  other  women,  the  hus- 
bands of  no  two  of  whom  followed  the  same  pro- 
fession. In  an  attitude  of  protest  towards  the  work 
of  those  twelve  husbands,  the  women  made  their 
several  complaints.  The  one  would  advise  her 
daughter  not  to  marry  a  clergyman,  —  his  life  is 
too  much  absorbed  in  parish  work,  and  he  is  con- 
stantly run  after  by  other  women;  the  next  would 
never  marry  a  lawyer,  —  he  brings  his  work  home 
with  him,  and  sits  up  until  two  o'clock;  another 
would  advise  against  a  coal  operator,  —  he  is  al- 
ways worried  to  death  about  the  strikes  and  prices, 
and  if  he  happens  to  have  a  clear  week,  he  runs  off 
to  visit  the  mines  in  West  Virginia.  The  doctor's 
wife  protests  that  her  life  is  insupportable;  her 
husband's  hours  are  monstrous;  she's  never  sure  of 
him;  he  never  takes  her  to  the  opera,  and  he  has  not 
been  to  a  church  for  two  years,  except  for  a  funeral. 
He's  killing  himself  for  other  people,  who  are  en- 
tirely selfish  and  ungrateful.  And  so  the  talk  went 
round  the  table,  —  not  a  woman  there  but  would 
have  her  husband  change  his  work. 


248  A  Doctor* 5  Table  Talk 

I  don't  believe  in  the  moral  of  that  story,  my  boy. 
Those  women  were  not  telling  the  truth.  Each  was 
trying  to  out-talk  the  last.  At  heart,  each  probably 
believed  in  her  husband  and  his  doings.  They  did 
show,  though,  how  no  profession,  no  calling,  can  be 
altogether  comfortable  for  all  concerned.  And  fur- 
ther, —  no  profession  can  be  anything  but  ashes, 
gall,  and  bitterness  if  your  heart  be  not  in  it. 

For  myself,  I  love  my  profession,  as  you  know, 
but  I  rarely  encourage  young  seekers  to  follow  it. 
It  is  too  fine  a  calling  lightly  to  be  entered  upon. 
When  some  flabby-minded  patient  says  to  me: 
"Surgery  always  did  interest  me;  I  came  near  being 
a  doctor  myself,"  my  only  possible  reflection  must 
be  that  medicine  and  surgery  have  had  a  fortunate 
escape.  Those  things  are  trifles;  but  the  anxious 
father  of  a  weathercock  son  is  not  to  be  lightly 
regarded  when  he  comes  to  me  with  the  question, 
"Shall  I  put  my  boy  into  medicine.?  He  seems  to 
have  a  fancy  for  it."  My  inclination  is  to  groan, 
to  beat  my  head,  and  to  shout  No  !  No  !  Then  I 
remember  a  little  chapter  of  my  own  youth :  I  had 
always  promised  my  dear  father,  your  grandfather, 
that  I  would  'go  into  medicine.'  He  himself  and 
my  elder  brother  were  lawyers.  One  day  in  my  sen- 


Scriba  to  his  Son  Thomas  249 

ior  year  I  walked  with  my  foolish  friend  Brattle 
through  the  college  grounds.  He  pointed  to  the 
law  school,  and  said,  "I  go  there  next  year.  How 
about  you?" 

"I'm  In  for  medicine,"  I  said. 

"Pshaw,"  he  retorted.  "Come  with  us  to  the 
law  school,"  and  he  named  half  a  dozen  of  our 
friends,  who  would  go  with  him.  "Law  is  the  pro- 
fession for  you.  No  gentleman  studies  medicine." 
And,  do  you  know,  so  feeble  was  my  resolution, 
and  so  impudent  his  urging,  that  almost  he  per- 
suaded me.  I  know  now  that  he,  too,  was  an  Ass,  a 
sorry,  Pompous  Ass.  Later,  my  wise  father's  look 
of  scorn,  a  look  without  words,  upset  the  silly 
Brattle  argument,  and  swung  me  back  into  my 
place. 

All  the  same,  medicine,  like  most  scientific  call- 
ings, is  an  exacting  mistress.  Men  follow  other 
pursuits,  with  more  or  less  satisfaction,  as  means 
to  an  end,  —  to  provide  a  living  and  to  support 
their  families.  You  may  not  so  treat  medicine. 
You  must  follow  it  as  the  end  itself,  else  will  your 
life  be  wretched.  That  is  the  fundamental  fact 
about  medicine,  which  escapes  the  superficial  critic. 
Like  the  doctor's  wife  at  the  lunch  party,  he  finds 


250  A  Doctor^ s  Table  Talk 

fault  because  of  surface  discomforts.  It's  as  though 
the  astronomer's  wife  were  to  scold  because  the 
astronomer  must  be  up  o'  nights  if  he  would  learn 
the  stars.  These  things  must  needs  be. 

You  are  to  know  that  there  are  two  broad  motives 
for  a  man's  following  medicine :  either  he  loves  his 
kind,  and  wishes  to  serve  them;  or  he  loves  science, 
and  would  fain  pursue  it.  There  are  no  other  mo- 
tives which  can  lead  one  to  distinction  among  us. 
You  see  that  in  a  fashion  a  doctor  must  be  some- 
thing of  a  missionary,  something  of  an  idealist,  and 
very  much  of  an  enthusiast.  He  must  have  breadth 
of  vision,  sanity;  a  mind  capable  of  work  without 
flagging;  readiness  to  accept  the  new,  courage  to 
reject  the  old;  optimism,  and  a  scorn  of  that 
crabbed  skepticism  which  glories  in  intrenched 
dogma.  Dogma  has  no  place  in  the  vocabulary  of 
science;  nor  has  heresy.  Remember  that  Voltaire 
defined  a  heretic  as  a  man  who  does  not  believe  as 
I  do.  Above  all,  a  doctor  must  have  sound  health 
—  during  his  early  years,  at  least. 

You  may  say  that  I  am  hard  on  you;  that  I  have 
set  an  ideal  standard  which  no  physician  attains. 
Of  course  I  have.  None  but  the  gods  attain  their 
ideals ;  but  you  must  have  ideals,  none  the  less.  And 


Scriba  to  his  Son  Thomas  251 

I  am  talking  of  the  qualities  we  see  in  leaders.  No 
proper  man  embarks  on  an  enterprise  among  men 
except  with  the  determination  to  succeed  and  to 
lead.  If  you  go  into  medicine  you  must  expect  to 
encounter  the  best  minds  of  our  time.  Gradually 
It  has  come  home  to  me  that  the  leaders  in  medicine 
are  remarkable  men.  Among  such  you  should 
strive  some  day  to  mingle  as  an  equal.  I  believe 
you  to  have  a  good  mind,  a  white  soul  and  capacity 
for  work.  Those  are  useful  assets.  You  are  eigh- 
teen years  old,  with  one  more  year  at  school. 
Whether  you  become  a  practitioner  or  a  research 
man,  —  student  and  teacher,  —  you  have  ten  or 
twelve  years  of  study  ahead,  before  you  can  sup- 
port yourself  or  marry  a  wife.  This  is  a  fact  not  to 
be  forgotten. 

You  are  a  boy  still.  Take  three  more  years  be- 
fore determining.  Look  about  you.  See  something 
of  older  men.  Three  years  from  now  you  will  under- 
stand me  better.  In  this  letter  I  do  not  try  to  per- 
suade. I  have  put  down  facts  for  your  contempla- 
tion. Keep  the  letter  and  read  it  again  in  the  middle 
of  your  college  course. 

My  dear  Tom,  you  must  know  that  I  shall  be 
Very  happy,  should  you  decide  some  day  to  join 


252  A  Doctor  s  Table  Talk 

me.  You  will,  indeed,  be  a  staff  for  my  old  age.  So 
much  I  think  it  fair  to  say. 

The  comparing  of  experiences,  and  the  balancing 
of  promise  against  accomplishment,  is  one  of  the 
pleasures  of  maturity,  and  sometimes  one  of  its 
pains.  Out  of  the  twenty-four  men  from  my  college 
class,  who  "went  into"  medicine,  eighteen  still 
write  themselves  "Doctor."  That  does  not  mean 
that  a  quarter  of  our  number  have  forsaken  medi- 
cine for  other  callings.  Those  six  men,  no  longer  in 
our  ranks,  are  either  dead  or  they  never  matricu- 
lated at  a  medical  school.  Here  is  an  interesting 
fact  about  physicians,  a  fact  unique,  —  they  rarely 
change  their  job.  You  don't  hear  it  said  of  a  man 
active  in  the  world  that  he  used  to  be  a  doctor. 
Physicians  sometimes  retire,  but  not  for  change  of 
business.  This  is  true  of  no  other  class  of  men. 
Medicine  gets  a  grip  which  is  seldom  loosened.  It 
has  a  fascination  all  its  own.  There  is  a  peculiar 
freemasonry,  as  there  is  a  peculiar  code  of  ethics, 
among  doctors. 

You  must  remember  that  in  my  time  the  classes 
graduated  from  our  great  universities  were  small 
as  compared  with  the  classes  of  to-day.  Of  my  own 
class  there  were  but  one  hundred  and  seventy-two, 


Scriba  to  his  Son  Thomas  253 

all  told.  All  our  eighteen  doctors  have  done  well. 
In  trying  to  classify  them  I  have  marked  them  as 
distinguished,  i;  superior,  9;  modest,  8.  By  "dis- 
tinguished" I  mean  a  man  of  international  reputa- 
tion, who  has  made  solid  contributions  to  medicine. 
By  "superior,"  a  man  widely  known  at  home,  who 
holds  responsible  positions  as  a  teacher  and  clini- 
cian. A  "modest"  physician  is  one  who  devotes 
himself  to  taking  care  of  the  sick  and  attending  to 
his  own  proper  business.  Though  I  have  thus  arbi- 
trarily grouped  these  men,  I  am  by  no  means  sure 
that  each  is  properly  placed.  For  instance,  I  sup- 
pose your  kind  godfather,  Dr.  Primrose,  must  be 
put  in  the  "modest"  group,  though  his  services 
have  been  very  great.  Again,  Dr.  Ely  might  well 
be  called  "distinguished."  He  is  known  widely  in 
this  country  and  in  Europe  as  a  brilliant  practitioner 
and  an  able  writer,  but  he  cannot  be  called  an 
original  investigator.  He  Is  "superior."  On  the 
whole,  I  think  I  am  justified  in  calling  my  old 
friend  Blair,  of  Liverpool,  the  one  truly  "distin- 
guished "  doctor  of  us  all.  His  career  is  interesting, 
and  it  teaches,  among  other  lessons,  that  the  boy 
is  not  always  father  of  the  man.  Blair  was  "easy" 
in  college.   For  the  first  two  years  he  did  nothing, 


254  ^  Doctor's  Table  Talk 

except  play  amiably.  Then  he  disappeared  for  a 
year,  either  removed  by  his  father  or  rusticated. 
That  year  of  absence  seems  to  have  matured  him, 
for  he  returned  to  us  a  student.  He  was  gi  aduated 
in  good  standing,  and  went  with  me  to  the  medical 
school.  Even  there  he  was  not  oppressive,  —  merely 
a  good  average  man.  We  had  adjoining  desks  in 
the  chemical  laboratory,  and  I  remember  him  as 
painstaking,  slow,  and  thorough.  Then  we  drifted 
apart.  He  became  a  house-physician,  I  a  house- 
surgeon.  He  immersed  himself  in  internal  medi- 
cine, especially  in  diseases  of  the  chest.  He  has  the 
rare  faculty  of  perceiving  in  what  a  subject  is  weak; 
and  has  the  capacity  and  insight  to  hurl  himself 
at  the  problem  and  produce  a  remedy.  He  studied 
in  Europe  when  modern  work  on  the  blood  was 
new.  He  came  home,  was  called  by  Superbus  to 
Liverpool,  when  the  great  new  university  hospital 
was  founded,  and  there  he  is  to-day.  He  has  been 
through  all  the  teaching  and  clinical  grades,  from 
Resident  up;  and  now,  since  the  resignation  of 
Superbus,  Blair  is  a  full  professor  and  head  of  his 
department.  He  is  some  twenty-two  years  in 
practice;  he  Is  known  the  world  over  for  his  contri- 
butions to  our  knowledge  of  certain  fevers,  and  of 


Scriba  to  his  Son  Thomas  255 

diseases  of  the  blood  and  of  the  heart.  He  is  a  tire- 
less worker;  a  careful  and  informing  teacher,  a  pro- 
found and  convincing  writer,  and  a  brilliant  speaker. 
To  these  pleasant  qualities  he  adds  a  capacity  for 
practice.  Through  a  large  section  of  our  country 
he  is  in  demand;  he  flourishes  as  a  prosperous  con- 
sultant; and  with  it  all  he  is  the  same  good  friend 
and  agreeable  companion  that  we  knew  twenty- 
five  years  ago.  I  believe  him  to  be  a  happy  man. 
Well,  now;  does  all  that  sound  attractive  to  you? 
I  dare  say  it  does  not,  and  yet  I  have  given  you  in 
outline  the  story  of  the  most  successful  doctor 
of  my  own  group.  You  are  old  enough  to  regard 
somewhat  the  philosophy  of  life,  and  you  recall  the 
old  saying  that  what  is  one  man's  meat  is  another 
man's  poison.  How  can  you,  a  school-boy,  appre- 
ciate the  accomplishments  of  a  mature  man,  and 
sympathize  in  his  life-work?  The  other  day  I  asked 
the  son  of  a  distinguished  novelist  if  he  remembered 
a  certain  recent  writing  of  his  father.  "Oh,  no," 
said  the  boy,  "that's  in  one  of  father's  books.  He's 
writing  'em  all  the  time,  but  I  never  read  'em." 
In  my  simplicity  I  had  supposed  that  he  knew  and 
rejoiced  in  every  word  of  his  father's  writings.  So, 
no  doubt,  you  are  untouched  by  the  dry  details  of 


256  A  Doctor's  Table  Talk 

Blair's  life.  The  personal  human  experiences,  the 
adventures,  the  hardships  of  a  doctor's  life  are 
what  would  appeal  to  you,  —  and  Dr.  Blair  has 
had  them  in  plenty.  There  are  a  few  delightful 
books  telling  about  such  things.  When  you  are  a 
little  older,  read  the  "Lives"  of  Pare  and  Pasteur 
in  France;  of  Harvey,  Hunter,  Huxley,  and  Lister 
in  England;  of  Rush,  Warren,  Howe,  and  Bigelow 
in  America.  All  these  were  high-hearted,  able  men, 
—  men  of  action,  men  whose  works  still  live.  Such 
are  a  few,  but  there  are  hundreds  of  others  you 
should  know.  As  for  the  fiction  writers,  —  they 
do  not  understand  us.  They  draw  us  as  inane  sen- 
timentalists, as  simpering  toadies,  or  as  vulgar 
brutes.  Oliver  Wendell  Holmes  knew  us,  of  course; 
but  almost  alone  among  the  novelists  George 
Eliot  in  "Middlemarch,"  and  Robert  Grant  in 
"Unleavened  Bread,"  catch  the  true  scientific 
spirit  and  the  point  of  view  of  the  cultivated  and 
sincere  physician. 

Medicine  should  appeal  to  the  imagination  of 
adventurous  youth.  Of  all  the  highly  developed 
pursuits  in  civil  life,  it  is  perhaps  the  most  perilous 
and  the  most  varied.  The  contagion  of  the  casual 
patient,  the  epidemic  of  the  slums,  the  scourge  of 


Scriba  to  his  Son  Thomas  257 

the  tropics,  the  problems  of  country  practice,  the 
fascination  of  laboratory  study,  the  trials  of  the 
exploring  party,  and  the  hazards  of  the  battle-field 
are  incidents  of  medicine.  The  doctor  is  always 
present.  From  the  cradle  to  the  grave,  on  land  and 
on  sea,  he  is  in  demand.  For  him  who  has  eyes  to 
see,  and  an  understanding  heart,  the  physician's 
calling  is  one  of  endless  diversion,  of  constant 
interest,  of  broadening  content. 

Think  of  these  things,  betimes;  and  remember 

that  I  am, 

With  entire  sympathy, 

Your  affectionate 

Father. 


THE  END 


<#' 


CAMBRIDGE  .  MASSACHUSETTS 
U  .   S   .  A 


Date  Due 

PRINTED  IN  U.S.*.            CAT.   NO.   24    161               ffiS 

^  000 


509  982 


\ 


W  9 
M962d 


1912 
M\amford,  James  Grepory 
A  doctor's  table  talk 


W  9 

M962d 
1912 
Mumford,  James  Gregory 
A  doctor's  table  talk 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


